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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:
- Obtain an electronic signature from IdenTrust Inc.
Upon opening the form, if you don't already have a digital signature on your PC,
you will be directed to the IdenTrust Inc. website to obtain
an electronic signature. The entire process of obtaining the electronic
signature will take 5-10 business days.
Note: Adobe 6.x is required to apply a digital
signature
(You only have to do this one time. Thereafter, you will use the same signature.)
- Fill out the form, making sure to fill in the required fields (marked
with a red asterisk (*)). If you do not fill in all
the required fields, you will not be able to submit the form.
It is recommended that you print the form prior to submitting, and keep the hardcopy for your records.
To do so, use the [Print] button provided near the top of the form.
- Click on the [Submit] button near the top of the form. A message will appear noting that the form
has been received and will provide an identification number. It is recommended that you record the ID
number on your hardcopy.
- If you have questions about filling/submitting these forms or need other forms assistance, you can send DFEC a question via e-mail by clicking
DFEC-FormsAssistance. DFEC will respond to your question via e-mail.
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 |
CA-2a* |
Notice of Recurrence |
CA-5* |
Claim for Compensation by Widow, Widower, and/or Children |
CA-5b* |
Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren |
CA-6 |
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) |
CA-7a* |
Time Analysis Form, used for claiming compensation, including
repurchase of paid leave |
CA-7b |
Leave Buy Back (LBB) Worksheet/Certification and Election |
CA-10 |
What A Federal Employee Should Do When Injured At Work |
CA-12* |
Claim For Continuance of Compensation Under the Federal
Employees' Compensation Act |
CA-17* |
Duty Status Report |
CA-20** |
Attending Physician's Report |
CA-35 |
Evidence Required in Support of a Claim for Occupational
Disease |
CA-278 |
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act |
CA-721* |
Notice of Law Enforcement Officer's Injury Or Occupational
Disease |
CA-722* |
Notice of Law Enforcement Officer's Death |
CA-1031 |
Letter to Dependants to Verify Claimant Support |
CA-1074 |
Letter to Parents in Death Claim Development |
CA-1108* |
Statement of Recovery Letter with Long Form |
CA-1122* |
Statement of Recovery Letter with Short Form |
CA-2231* |
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 |
OWCP-16* |
Rehabilitation Plan And Award |
OWCP-17* |
Rehabilitation Maintenance Certificate |
OWCP-20* |
Overpayment Recovery Questionnaire |
OWCP-44* |
Rehabilitation Action Report |
OWCP-04 |
Uniform Billing Form |
OWCP-915* |
Claim For Medical Reimbursement
Form OWCP-915 replaces CA-915 |
OWCP-957* |
Medical Travel Refund Request |
OWCP-1168 |
Provider Enrollment form |
OWCP-1500* |
Health Insurance Claim Form |
HCFA-1500* |
Health Insurance Claim Form |
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