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September 23, 2008    DOL Home > Find It! By Form > DOL Form   

DOL Form CA-1

View ESA-OWCP-DFEC's Form Online htm
Agency: ESA-OWCP-DFEC
Title: DFEC CA-1, Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
Form Description: DFEC CA-1, Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation: This form is used by a federal employee to provide notice of traumatic injury and to claim continuation of pay (compensation). The form must be filed with one's employing agency.
OMB Control Number:
OMB Expiration Date:




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