Roll Type

1

1

CHAR/1

ROLL TYPE

Types of payments

P = Periodic Roll
D = Death Roll
S = Supplemental Roll

Case number

2

10

CHAR/9

CASE-NO

Unique identifier for each case. Generated from the Case Management File.

Case Suffix

11

11

CHAR/1

CASE-SUFFIX

Blank

Date Entry

12

19

Date/8

ENTRY-DATE

Date that the case is entered into the sequent system for payment

YYYYMMDD
00000000 = N/A

Employee Name

20

61

CHAR/42

EMPLOYEE

Claimant’s Name

LAST 20 - 34
FIRSTI 40
MID 41 - 49

Date of Birth

62

69

Date/8

DOB

Date of birth

YYYYMMDD
00000000 = N/A

Social Security NO.

70

78

CHAR/9

SSN

Claimant’s Social Security Number

Payee Name

79

113

CHAR/35

PAYEE

Name of Payee

Payee Address

114

148

CHAR/35

ADDR1

Payee’s mailing address for check

Street number; PO Box

Payee Address

149

183

CHAR/35

ADDR2

Additional Mailing address

Payee Address

184

192

CHAR/9

ADDR2

Additional Mailing address

EFT Info

114

148

CHAR/35

ADDR1

Direct Deposit

EFT Info

149

165

CHAR/35

ACCT-NO

Payee’s Electronic Funds Transfer (EFT) information

EFT Info

166

166

CHAR/1

ACCT-TYPE

S=Savings
C=Checking

EFT Info

167

183

CHAR/1

FILLER

Blank

EFT Info

184

192

NUM/9

ROUT-NO

Account Routing Number

Used only if Claimant receives payment by EFT

Filler

193

216

CHAR/34

FILLER

Blank

City

217

243

CHAR/35

ADDR4

City

State

237

238

CHAR/2

STATE

State

Zip

239

243

NUM/5/9

ZIP CODE

Zip Code

Filler

244

247

CHAR/4

Blank

Payee Relationship Code

248

249

CHAR/2

PAYEE-REL-CODE

Code used primarily to indicate a payee’s relationship to a claimant. Is also used to indicate:

- payment for a CPI adjustment (CI)

- payment made to OWCP (CR)

- payment to an agency on behalf of a claimant (CP)

- Deduction form compensation to repay OWCP (AR)

- Miscellaneous Deduction Type Code

CL = Claimant
CI = CPI Adjustment
CP = Case Payee, payment to a Beneficiary
CR = Cash Receipt, indicates recouping of overpayment
AR = Accounts Receivable
GR = Guardian
W = Widow
D = Daughter
SO = Son
F = Father
M = Mother
B = Brother
SI = Sister
GP = Grandparent
GC = Grandchild
SP = Spouse
CO = Case Organization
FE = FERS Offset
GO = Guardian Organization
LB = Leave Buy Back
LE =Law Enforcement
TP = Third Party
TC = Long Term Care
OP = OPM/CSRF
AR = Accounts Receivable
XX = Other Offset
OB = Option B Freeze Withholding
XD = Other Deduction
JF = Dental
JG = Vision
JH = Combo

Chargeback Code

250

253

CHAR/4

CB

Agency that will be charged for the payee’s workmen’s compensation costs

Valid Chargeback Agency Code

Date of Injury

254

261

DATE/8

DOI

Date the worker was injured

YYYYMMDD
00000000 = N/A

District Office Number

262

263

CHAR/2

DIST

District Office Code

Boston - 01
New York 02
Philadelphia 03
Jacksonville 06
Cleveland 09
Chicago 10
Kansas City 11
Denver 12
San Francisco 13
Seattle 14
Dallas 16
Washington 25
National Office 50

Pay Type

264

264

CHAR/1

PAY-TYPE

Payment type

0 = Adjustment
1 = Disability
2 = Leave Buy Back
3 = WEC
4 = Direct Payment
5 = Incarcerated
6 = Termination Expenses
7 = Death
8 = Manual Payment
9 = Scheduled Award
A = Death Lump Sum
B = Cash Receipt
C = FECS Payments Adjustment

Examiner

265

267

CHAR/3

EXAM

Claims Examiner initials

Certifier

268

270

CHAR/3

CERT

Senior Claims Examiner Initials

Batch ID

271

276

CHAR/5

BATCH-ID

Keying Batch ID number

DMCS – Cash Receipt Transactions (ALL)

Filler

271

276

CHAR/3

FILLER

Empty for transactions after 01/2005.

Blank

Pay Rate

277

280

NUM/4

PAY-RATE

Pay rate of claimant at the Date of Injury, Date of Recurrence or Start of Disability

0000/Refer to EXPANDED RECORD

Rate Type

281

281

CHAR/1

RATE-TYPE

Indicates whether payment is to be made weekly or monthly

A = Annual
W = Weekly
M = Monthly

Last Pay Rate

282

285

NUM/4

LAST-PAY-RATE

Previous different pay rate of the current rate.

0000/Refer to EXTENDED RECORD

Compensation Rate

286

288

NUM/4

COMP-RATE

Percent of pay rate that claimant will be compensated for based on number of eligible dependents or beneficiaries.

0000/Refer to EXPANDED RECORD

From Date

289

296

DATE/8

FROM-DATE

Compensation period starting date

YYYYMMDD
00000000 = N/A

To Date

297

304

DATE/8

TO-DATE

Compensation period ending date

YYYYMMDD
00000000 = N/A

Compensation Amount

305

309

NUM/5

COMP-AMT

Pretax, pre-deduction payment amount.

OWCP calculated amount of compensation prior to deductions and authorized additions

00000/Refer to EXPANDED RECORD

DMS Record

310

314

NUM/5

ACCT-PAY-RECV

Repayment amount received from claimant or other source

00000/Refer to EXTENDED RECORD

Net Compensation

315

319

NUM/5

NET-COMP

Payment amount after taxes and deductions

00000/Refer to EXPANDED RECORD

HBI Code

320

322

CHAR/3

HBI-CODE

Valid Health Benefit Insurance Code

N/A = No HBI Benefits applied.

Employee HBI Cost

323

326

NUM/4

EMP-HBI-COST

Deduction form compensation for employee’s contribution for Health Benefit Insurance

0000/Refer to EXPANDED RECORD

Agency HBI Cost

327

330

NUM/4

AGY-HBI-COST

Agency contribution for employee’s Health Benefit insurance

0000/Refer to EXPANDED RECORD

HBI Date

331

338

DATE/8

HBI-FROM-DATE

Health Benefit Insurance coverage beginning date

YYYYMMDD
00000000 = N/A

HBI Date

339

346

DATE/8

HBI-TO-DATE

Health Benefit Insurance coverage ending date

YYYYMMDD
00000000 = N/A

Optional Life Insurance

347

347

CHAR/1

OI

Indicates the age group (1-7) of the claimant who has selected Optional Life Insurance

N = No
A-E

Optional Life Insurance Cost

348

350

NUM/3

OI-COST

Cost to be deducted from compensation to pay for Optional Life Insurance

000/Refer to EXTENDED RECORD

Date of Disability

351

358

DATE/8

DOI-DIS-RCR

Date claimant was disabled; pay rate effective date.

YYYYMMDD
00000000 = N/A

Calendar \ Work

359

359

CHAR/1

CALEN-WORK-DAY

Distinguishes if payment corresponds to days of the week(calendar) or number of hours worked(work days)

C=Calendar
W=Week
Blank

Intermittent

360

360

CHAR/1

INTERMITTENT

Indicates discontinuous periods of disability; Distinguishes if payment is calculated based on weekly or daily basis.

Y=Yes
N=No

Hours worked in a day

361

374

CHAR/14

HOURS-IN-DAY-TABLE

Indicates hours worked each day for claimant with irregular work schedule; Corresponds with calendar /work day field. Shows hour and days worked

0=No Hours worked

Time Lost

375

378

CHAR/3

TIME-LOST

Accounting for time lost day s

Time Lost

379

380

CHAR/3

HOURS-LOST

Accounting for time lost hours

Supplemental

375

378

CHAR/4

SUP-DAY-WHOLE

Conversion of time not at work

Supplemental

379

380

CHAR/2

SUP-DAY-FRACTION

Conversion of time not at work

Filler

381

384

CHAR/4

Blank

Expiration Date

385

392

DATE/8

EXPIRE-DATE

Date compensation will be terminated

YYYYMMDD
00000000 = N/A

Days to go

393

396

CHAR/4

DAYS-TOGO

Days of compensation remaining;

0000/Refer to EXTENDED RECORD

Attendant Rate

397

400

NUM/4

ATTEND-RATE

Rate per week for a health care assistant

0000/Refer to EXTENDED RECORD

Attendant Date

401

408

DATE/8

ATTEND-DATE

Date compensation for health care attendant began

YYYYMMDD
00000000 = N/A

Attendant Allowance

409

412

NUM/4

ATTEND-ALLOW

Amount reimbursed for a health care attendant

0000/Refer to EXTENDED RECORD

WEC Rate

413

416

NUM/4

AE-WEC-RATE

Estimation done by rehabilitation specialist of injured worker’s earning capacity; Estimated pay rate based on employee’s calculated wage earning capacity.

0000/Refer to EXTENDED RECORD

WEC Date

417

424

DATE/8

AE-WEC-DATE

Effective pay rate date for actual earning or calculated wage earning capacity.

YYYYMMDD
00000000 = N/A

WEC Amount

425

428

NUM/4

AE-WEC

Actual pay rate or calculated pay rate (wage earning capacity)

0000/Refer to EXTENDED RECORD

Scheduled payment effective date

351

358

DATE/8

SCHE-EFF-DATE

Pay rate effective date

YYYYMMDD
00000000 = N/A

Days of Compensation

359

364

CHAR/4

DAYS-OF-COMP

Number of days paid according to schedule

Percent of disability

365

367

CHAR/3

DESC-AMT1

Percent of disability

Member affected

368

381

CHAR/14

DESC-1

Not used

Blank

2^nd Disability

382

382

CHAR/1

DESC-2

Not used

Blank

Attendant Rate

383

386

CHAR/4

SCHE-ATTEND-RATE

Weekly rate for a health care assistant

0000/Refer to EXTENDED RECORD

Attendant Date

387

394

DAE/8

SCHE-ATTEND-DATE

Start Date compensation for an attendant; date payment started.

YYYYMMDD
00000000 = N/A

Attendant Allowance

395

398

NUM/4

SCHE-ATTEND-ALLOW

Amount paid for an attendant

0000/Refer to EXTENDED RECORD

FILLER

399

401

CHAR/3

Blank

Supplemental Payment flag

402

402

CHAR/1

SCHE-SUP-FLAG

Indicates payment for a partial payment period;
Indicates a supplemental payment for a schedule award

Y = Yes
N, Blank = No

Days to go

403

406

CHAR/4

DAYS-TO-GO

Number of days remaining for compensation

0000/Refer to EXTENDED RECORD

Start date

407

414

DATE/8

SCHE-START-DATE

Initiation of schedule award

YYYYMMDD
00000000 = N/A

Award Expiration Date

415

422

DATE/8

SCHE-AWD-EXP-DATE

Termination of schedule award

YYYYMMDD
00000000 = N/A

Compensation Paid

423

427

DATE/6

COMP-PAID-TO-DATE

Total compensation paid

000000

FILLER

428

428

CHAR/1

Blank

Date of death

351

358

DATE/8

DOI-DIS-RCR-DOD

Date of reported injury resulting in death

YYYYMMDD
00000000 = N/A

Number of beneficiaries

359

360

CHAR/2

NUM-BENE

Number of beneficiaries receiving benefits

Beneficiary type

361

364

CHAR/1

WIDOW

Number of Widows entitled to payments.

0-9

Beneficiary type

362

362

CHAR/1

CHILDREN

Number of Children entitled to payments.

0-9

Beneficiary type

363

363

CHAR/1

PARENTS

Number of Parents entitled to payments.

0-9

Beneficiary type

364

364

CHAR/1

SIBLINGS

Number of Siblings entitled to payments.

0-9

Parent’s percentage

365

366

NUM/2

PARENT-PERCENT

Percentage of compensation that parent’s receive

Parent whole

367

367

CHAR/1

PARENT-WHOLE

Parent as sole beneficiary

0,1

Sibling(s) whole

368

368

CHAR/1

BROSIS-WHOLE

Sibling as sole beneficiary

0,1

Beneficiary Expiration date

369

376

DATE/8

BENE-EXP-DATE

Date next beneficiary expires

YYYYMMDD
00000000 = N/A

Burial expenses

377

380

NUM/4

BURIAL-EXP

Compensation for burial

0000/Refer to EXTENDED RECORD

Transportation Expenses

381

384

NUM/6

TRANSPORT-EXP

Compensation for transport of body

0000/Refer to EXTENDED RECORD

Termination

385

387

NUM/3

TERMINATION

Compensation for termination of permanent employment status

000/Refer to EXTENDED RECORD

Date of death

388

395

DATE/8

DOD

Employee’s Date of Death

YYYYMMDD
00000000 = N/A

Old compensation rate

396

400

NUM//5

OLD-COMP-RATE

Used for recalculated cases

0000/Refer to EXTENDED RECORD

Beneficiary Name

401

419

CHAR/19

BENE-NAME

Not used

Blank

Comp rate at LS

420

422

CHAR/3

COMP-RATE

Percent of pay rate that claimant will be compensated for based on number of eligible dependents or beneficiaries.

000/Refer to EXTENDED RECORD

Comp Pay Rate at LS

423

426

CHAR/4

COMP-PAY-RATE

Compensation pay rate at last serviced

0000/Refer to EXTENDED RECORD

Filler

427

428

CHAR/2

Blank

First time flag

429

429

CHAR/1

OI-TEMP

Not used

Blank

Adjustment Indicator

430

430

CHAR/1

ADJ-IND

Not used

Blank

Payment Date

431

438

DATE/8

CHECK-DATE

Date of check that was issued; Payment date

YYYYMMDD
00000000 = N/A

Check Number

439

446

CHAR/8

CHECK-NUM

Sequential number unique to each District Office for a particular check run

Treasury Check Indicator

447

447

CHAR/1

TRCHECK-IND

Not used

Blank

Activity

448

449

CHAR/2

ACTIVITY

Indicating coverage by FECA or by Fringe Acts

01 = Federal Civilian
02 = Reservists(no mins, no CPI’s)
03 = Civil Air Patrol
04 = Reserve Officer Training
05 = Maritime War Risk
06 = Federal Officer Training
07 = War – Connected
08 = Civilian War Benefits
09 = Total Benefits, War Claims
10 = Poverty Programs
11 = Law Enforcement Officers
12 = Coast Guard Aux
13 = Job Corps
14 = Neighborhood youth Enrollees
15 = Military reservist survivors
16 = Members of the woman’s army
auxiliary corps
17 = Peace corps voluntary leaders
00, Blank = Null

Postal Service HBI beginning date

450

457

DATE/8

HBI-USPS-START-DATE

Start date for Health Benefits Insurance deductions for postal employees.

YYYYMMDD
00000000 = N/A

Postal Service Funding Amount

458

461

NUM/4

HBI-USPS-FUNDING

Additional compensation for Health Benefits Insurance made by USPS workers

0000/Refer to EXTENDED RECORD

Pay Occurrence

462

462

CHAR/1

PAY-OCCURRENCE

Not used

Blank

Expired Benefit Match Code

463

463

CHAR/1

BENE-MATCH-CODE

Not used

Blank

Historical Type Flag

464

464

CHAR/1

HIST-TYPE-FLAG

Flag used to indicate that payment was manual; not system calculated

H = Manual
Blank = system

Cancel Check Flag

465

465

CHAR/1

CANCEL-CHECK-FLAG

Indicates that compensation check has been/will be cancelled.

P = Initial Check to be cancelled(earlier check data)
Y = Cancellation entry(later check date)
U = Original payment has been un-cancelled.

Recalculation Flag

466

466

CHAR/1

DTH-RECALC-FLAG

Not used

Blank

Cash Receipt

467

471

NUM/5

CASH-RECEIPT

Overpayment reimbursed, and other payments made to OWCP, i.e., a third party payment.

00000/Refer to EXTENDED RECORD

Gross Override

472

476

NUM/5

GROSS-OVERIDE

Override calculated gross amount of compensation, amount that compensation should be

00000/Refer to EXTENDED RECORD

Gross Override Date

477

484

DATE/8

OVERRIDE-DATE

Date of override

YYYYMMDD
00000000 = N/A

Not Historical Type Flag

485

485

CHAR/1

NOT-HIST

A

Health Benefits Transfer flag

486

486

CHAR/1

HBI-TRANSFER-FLAG

Indicates transfer of Health benefits from employing agency to DFEC

Y=Yes
N=No
Blank = N/A

Optional Life Insurance Class Codes

487

487

CHAR/1

OI-CLASS

Optional Life insurance class codes
Only if Optional Life Insurance = Y

Blank = N/A
C = Retired Coverage
D = Basic life + Std. Option A
E = Basic Life + Family Option C
F = Basic Life A&C

Basic Life + Additional Option x1
G = x1
H = x1+ Standard Option A
I = x1 + Family Option C
J = x1 + A&C

Basic Life Additional Option x2
K = x2 only
L = x2+ Standard Option A
M = x2 + Family Option C
N = x2 + A&C

Basic Life + Additional Option x3
O = x3only
P = x3 Standard Option A
Q = x3+ Family Option C
R = x3+ A&C

Basic Life Additional Option x4
S = x4 only
T = x4+ Standard Option A
U = x4 + Family Option C
V = x4 + A&C

Basic Life Additional Option x5
W = x5 only
X = x5+ Standard Option A
Y = x5 + Family Option C
Z = x5 + A&C

Optional Life Insurance – Salary

488

491

CHAR/4

SALARY

Not used

0000

Optional Life Insurance – Premium

492

494

CHAR/3

RETIRED-PREM

Not used

000

Optional Life Insurance From Date

495

502

DATE/8

OI-FROM-DATE

Date optional life insurance coverage began

YYYYMMDD
00000000 = N/A

Optional Life Insurance To Date

503

510

DATE/8

OI-TO-DATE

Date optional life insurance coverage ended

YYYYMMDD
00000000 = N/A

Third Party Flag

511

511

CHAR/3

THIRD-PARTY-FLAG

Third Party Payment

Y = Yes
Blank = No

Direct Payment

512

512

CHAR/1

DIR-PAYM

Indicates less previously paid, forces system to pay even when payment duplicates or overlaps

Y = Yes
Blank = No

Chargeback Adjustment Code

513

513

CHAR/1

CBADJ-CODE

Not used

Blank

Adjustment Code

514

514

CHAR/1

ADJ-CODE

Not used

Blank

Ret OI Code

515

515

CHAR/1

RET-OI-CODE

Code indicates type of optional insurance selected by claimant over 65

C = Claimant accepted PRBLI

Total OI Cost

516

518

CHAR/3

TOT-OI-COST

Total deduction for OI class = cost + retired premium + basic life premium

000/Refer to EXPANDED RECORD

Basic Life Insurance Premium

519

521

CHAR/3

BASIC-LIFE-PREM

Not used

000

Basic Life Total

522

524

CHAR/3

BASIC-LIFE-TOT

Not used

000

District Office Code

525

525

CHAR/1

UNIQUE-DIST

Alphabetic code associated with the district office

A-P

FILLER

526

532

CHAR/4

Blank

Pay Rate

533

539

NUM/7

EXPANDED-PAY-RATE

Pay rate of claimant at the date of injury, date of recurrence or start of disability.

Compensation Rate

540

544

NUM/5

EXPANDED-COMP-RATE

Percent of pay rate that claimant will be compensated for based on number of eligible dependents or beneficiaries.

04000
06666
07500
00000

Compensation Amount

545

552

NUM/8

EXPANDED-GROSS

Pretax, pre-deduction payment amount.

OWCP calculated amount of compensation prior to deductions and authorized additions.

Net Comp

553

560

NUM/8

EXPANDED-NET-COMP

Payment amount after taxes and deductions

Gross Override

561

569

NUM/9

EXPANDED-GROSS-OVERRIDE

Override calculated gross amount of compensation.

Employee HBI Cost

570

575

NUM/6

EXPANDED-EMP-HBI

Deduction form compensation for employee’s contribution for Health Benefit Insurance

Agency HBI Cost

576

581

NUM/6

EXPANDED-AGY-HBI

Agency contribution for employee’s Health Benefit Insurance

Total OLI

582

586

NUM/5

EXPANDED-TOT-OLI

Total Optional Life Insurance