View ESA-OWCP-DFEC's Form 1215-0116 Online
Agency: |
ESA-OWCP-DFEC |
Title: |
DFEC CA-721, Notice of Law Enforcement Officer's Injury Or Occupational Disease |
Form Description: |
DFEC CA-721, Notice of Law Enforcement Officer's Injury Or Occupational Disease: This form is used by law enforcement officers to submit a claim for injury or occupational injury. It is also used by the employing organization to file a report, and by the officer's attending physician to provide a medical report. |
OMB Control Number: |
1215-0116 |
OMB Expiration Date: |
Tuesday, August 31, 2010
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