Office of Workers' Compensation Programs (OWCP)
Division of Federal Employees' Compensation (DFEC)
Forms
OWCP's Division of Federal Employees' Compensation has made a variety of forms available online. These forms are only available in PDF format. In order to view and/or print PDF documents you must have a PDF viewer. It is highly recommended that you have the most current version (click on Adobe Acrobat Reader to download the current version) available on your workstation.
The forms in the list below may be completed manually via the print form option or electronically via the electronic fill/submit option:
Printable Forms
All of DFEC's online forms 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. Write or type the required information on the hardcopy and authorize the form, if applicable, with a hand-written signature. Then mail or fax the completed form to the DFEC office you normally send to for this process.
Fillable Forms
Forms noted with an asterisk (*) may be electronically filled. Simply click on the appropriate form, fill out the form using your computer keyboard and the <TAB> key or your mouse to navigate between form fields. Print the form (use the Print button on or near the top of the form), authorize the form (if applicable provide hand-written signature) and mail or fax the completed form to the DFEC office you normally send to for this process.
Submitable Forms
Select DFEC forms, noted with double asterisks (**) on the list of forms below, may be electronically filled and submitted to OWCP/DFEC. To do so, you must have Adobe Reader 6.x installed on your PC.
To electronically submit a DFEC form, follow these simple steps:
NOTE: When printing these files please remember to use the Adobe Acrobat Reader print icon or the [Print] button on the form, itself, and NOT your browser's print icon on the browser toolbar.
Form Number |
OWCP's Form Title / Description |
CA-1* |
Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation |
CA-2* |
Notice of Occupational Disease and Claim for Compensation |
Notice of Recurrence |
|
CA-5* |
Claim for Compensation by Widow, Widower, and/or Children |
Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren |
|
Official Supervisor's Report of Employee's Death |
|
CA-7* |
Claim for Compensation Form CA-7 replaces ALL prior versions of CA-7 & CA-8 (see FECA Bulletin No. 99-18) |
Time Analysis Form, used for claiming compensation, including repurchase of paid leave |
|
Leave Buy Back (LBB) Worksheet/Certification and Election |
|
What A Federal Employee Should Do When Injured At Work |
|
Claim For Continuance of Compensation Under the Federal Employees' Compensation Act |
|
Duty Status Report |
|
CA-20** |
Attending Physician's Report |
Evidence Required in Support of a Claim for Occupational Disease |
|
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act |
|
Notice of Law Enforcement Officer's Injury Or Occupational Disease |
|
Notice of Law Enforcement Officer's Death |
|
Letter to Dependants to Verify Claimant Support |
|
Letter to Parents in Death Claim Development |
|
Statement of Recovery Letter with Long Form |
|
Statement of Recovery Letter with Short Form |
|
Claim for Reimbursement Assisted Reemployment |
|
OWCP-5a** |
Work Capacity Evaluation Psychiatric/Psychological Conditions |
OWCP-5b** |
Work Capacity Evaluation Cardiovascular/Pulmonary Conditions |
OWCP-5c** |
Work Capacity Evaluation for Musculoskeletal Conditions |
Rehabilitation Plan And Award |
|
Rehabilitation Maintenance Certificate |
|
Overpayment Recovery Questionnaire |
|
Rehabilitation Action Report |
|
Uniform Billing Form |
|
Claim For Medical Reimbursement Form OWCP-915 replaces CA-915 |
|
Medical Travel Refund Request |
|
Provider Enrollment form |
|
Health Insurance Claim Form |
|
Health Insurance Claim Form |
|