See form instructions for Requests for Accommodations or Auxiliary Aids and Services. Employing Agency Portion For first CA-7 claim sent, complete sections 8 through 15. For subsequent claims, complete sections 12 through 15 only.
Forms | U.S. Department of Labor
All of the Federal Employees Program's online forms (with the exception of Forms CA-16 and CA-27) are available to print and to manually fill and submit. Simply click on the appropriate form and print it using the [Print] button provided near the top of the form.
Form CA-7 is used to claim compensation for wage loss while in a leave without pay (LWOP) status due to disability or absence to obtain medical treatment (after continuation of pay (COP) period for traumatic injury cases).
Filing Forms as an Injured Worker - DOL
Use this form to claim compensation in an established case for traumatic injury or occupational disease. A CA-7 may be filed in ECOMP both for cases which were initially filed via ECOMP as well as those submitted by another method.
If the employee is receiving continuation of pay and will continue to be disabled after 45 days, the form should be filed with OWCP 5 working days prior to the end of the 45-day period. The CA-7 also should be used to claim continuing compensation, when a …
INSTRUCTIONS FOR COMPLETING FORM CA-7 If the employee does not quality for continuation of pay (for 45 days), the form should be completed and filed with the OWCP as soon as pay stops.
Instructions for Completing Form CA-7A Time Analysis General: This form is used when claiming FECA compensation, including repurchase of paid leave. It must be used when claiming compensation for more than one consecutive period of leave. Instructions for Employee: Blocks 1, 2, and 3: Self-explanatory.
OWCP Forms - Federal Injury Centers
CA1 - Notice of Traumatic Injury CA2 - Notice of Occupational Disease CA2a - Notice of Recurrence CA7 - Claim for Compensation CA7a - Time Analysis Form CA7b - Leave Buy Back CA10 - What a Federal Employee Should Do ...
Form CA-7 Rev. Nov. 1999 Employing Agency Portion For first CA-7 claim sent, complete sections 8 through 15. For subsequent claims, complete sections 12 through 15 only.
How To Fill Out CA-7 Form – Federal Workers’ Compensation
Form CA-7 is used by federal workers seeking to claim compensation for traumatic injuries suffered while on the job, as well as those who may have sustained an occupational disease during the performance of work-related duties. This form may be …