OWCP Forms

  • CA-1 - Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation

  • CA-2 - Notice of Occupational Disease and Claim for Compensation

  • CA-2a - Notice of Recurrence; Agency

  • CA-5 - Claim for Compensation by Widow, Widower, and/or Children

  • CA-5b - Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren

  • CA-6 - Official Supervisor's Report of Employee's Death

  • CA-7 - Claim for Compensation

  • CA-7a - Time Analysis Form, used for claiming compensation, including repurchase of paid leave

  • CA-7b - (Leave Buy Back (LBB) Worksheet/Certification and Election

  • CA-10 - What A Federal Employee Should Do When Injured At Work

  • CA-12 - Claim For Continuance of Compensation Under the Federal Employees' Compensation Act

  • CA-17 - Duty Status Report

  • CA-20 - Attending Physician's Report

  • CA-35 - Evidence Required in Support of a Claim for Occupational Disease

  • CA-40 - Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a

  • CA-41 - Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity

  • CA-42 - Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity

  • OWCP-5a - Work Capacity Evaluation Psychiatric/Psychological Conditions

  • OWCP-5b - Work Capacity Evaluation Cardiovascular/Pulmonary Conditions

  • OWCP-5c - Work Capacity Evaluation for Musculoskeletal Conditions

  • VETS-4212 - Federal Contractor Reporting - Veteran Hiring

  • Agreement and Undertaking (Insurance Carrier) - LS-275ic

  • Agreement and Undertaking (Self-Insured Employer) - LS-275si

  • CA-278 - Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act

  • CA-721 - Notice of Law Enforcement Officer's Injury Or Occupational Disease

  • CA-722 - Notice of Law Enforcement Officer's Death

  • CA-1031 - Letter to Dependants to Verify Claimant Support

  • CA-1074 - Letter to Parents in Death Claim Development

  • CA-1108 - Statement of Recovery Letter with Long Form

  • CA-1122 - Statement of Recovery Letter with Short Form

  • CA-2231 - Claim for Reimbursement Assisted Reemployment