[Code of Federal Regulations]
[Title 20, Volume 1]
[Revised as of April 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 20CFR10.7]

[Page 16]
 
                      TITLE 20--EMPLOYEES' BENEFITS
 
CHAPTER I--OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR
 
PART 10_CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, 
 
                      Subpart A_General Provisions
 
Sec.  10.7  What forms are needed to process claims under the FECA?

    (a) Notice of injury, claims and certain specified reports shall be 
made on forms prescribed by OWCP. Employers shall not modify these forms 
or use substitute forms. Employers are expected to maintain an adequate 
supply of the basic forms needed for the proper recording and reporting 
of injuries.

------------------------------------------------------------------------
                 Form No.                               Title
------------------------------------------------------------------------
(1) CA-1..................................  Federal Employee's Notice of
                                             Traumatic Injury and Claim
                                             for Continuation of Pay/
                                             Compensation
(2) CA-2..................................  Notice of Occupational
                                             Disease and Claim for
                                             Compensation
(3) CA-2a.................................  Notice of Employee's
                                             Recurrence of Disability
                                             and Claim for Pay/
                                             Compensation
(4) CA-5..................................  Claim for Compensation by
                                             Widow, Widower and/or
                                             Children
(5) CA-5b.................................  Claim for Compensation by
                                             Parents, Brothers, Sisters,
                                             Grandparents, or
                                             Grandchildren
(6) CA-6..................................  Official Superior's Report
                                             of Employee's Death
(7) CA-7..................................  Claim for Compensation Due
                                             to Traumatic Injury or
                                             Occupational Disease
(8) CA-7a.................................  Time Analysis Form
(9) CA-7b.................................  Leave Buy Back (LBB)
                                             Worksheet/Certification and
                                             Election
(10) CA-16................................  Authorization of Examination
                                             and/or Treatment
(11) CA-17................................  Duty Status Report
(12) CA-20................................  Attending Physician's Report
------------------------------------------------------------------------

    (b) Copies of the forms listed in this paragraph are available for 
public inspection at the Office of Workers' Compensation Programs, 
Employment Standards Administration, U.S. Department of Labor, 
Washington, DC 20210. They may also be obtained from district offices, 
employers (i.e., safety and health offices, supervisors), and the 
Internet, at www.dol.gov./dol/esa/owcp.htm.

[63 FR 65306, Nov. 25, 1998; 63 FR 71202, Dec. 23, 1998]

                     Information in Program Records