Form Details


These forms are used for filing claims for wage loss or permanent impairment due to a Federal employment-related injury, and to obtain necessary medical documentation to determine whether a claimant is entitled to benefits under the Federal Employees Compensation Act (FECA), 5 USC 8101 et.seq.
Form #: CA 20
Agency: Department of Labor
Bureau: Employment Standards Administration
Common Name: FECA Medical Report Forms, Claim for Compensation
Type: Both Form and Instructions
Capability: [5] Fillable + Fileable + Signable
Format: pdf
Pages: 2
What's Needed: Adobe Reader  Download