Forms By Form Number

Welcome to our forms section. Here we have assembled all the necessary forms and their descriptions to complete your proceeding. You must have Adobe Acrobat Reader installed on your computer in order to download these forms from our site

• CA-1 - DFEC CA-1, Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation: This form is used by a federal employee to provide notice of traumatic injury and to claim continuation of pay (compensation). The form must be filed with one's employing agency.
• CA-10 - DFEC CA-10, What A Federal Employee Should Do When Injured At Work: This form indicates the actions a Federal employee should perform after being injured at work.
• CA-1031 - DFEC CA-1031, Letter to Dependants to Verify Claimant Support: This letter requsts information needed to verify support of dependents in compensation entitlement determinations.
• CA-1074 - DFEC CA-1074, Letter to Parents in Death Claim Development: This letter requsts information needed to verify decedent's support of dependent parents in compensation entitlement determinations.
• CA-1108 - DFEC CA-1108, Statement of Recovery Letter with Long Form: Representative's statement of recovery for third-party damage claims.
• CA-1122 - DFEC CA-1122, Statement of Recovery Letter with Short Form: Representative's statement of recovery for third-party damage claims.
• CA-12 - DFEC CA-12, Claim For Continuance of Compensation Under the Federal Employees' Compensation Act: Beneficiaries of deceased federal employees may complete and submit this form to request continuation of compensation under the Federal Employees' Compensation Act.
• CA-17 - DFEC CA-17, Duty Status Report: This form is provided for the purpose of obtaining a medical duty status report for the injured employee.
• CA-2 - DFEC CA-2, Notice of Occupational Disease and Claim for Compensation: This form is used by a federal employee to provide notice of occupational disease and to claim compensation. This form must be filed with one's employing agency.
• CA-20 - DFEC CA-20, Attending Physician's Report: This medical report is required before payment of compensation for loss of wages or permanent disability can be made to the injured employee. This information is required to obtain or retain a benefit.
• CA-2231 - DFEC CA-2231, Claim for Reimbursement Assisted Reemployment, This form is used by private employers to claim partial salary reimbursement for reemployment of an injured Federal employee. One must have a signed Cooperative Agreement with OWCP in order to claim such reimbursement.
• CA-278 - DFEC CA-278, Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act: This form is used to claim reimbursement of benefit payments and claims expense under the War Hazards Compensation Act.
• CA-2a - DFEC CA-2a, Notice of Recurrence: This form is used by a federal employee to provide notice of a recurrence of a traumatic injury or occupational disease, and to claim continuation of pay or compensation. The form must be filed with one's employing agency.
• CA-35 - DFEC CA-35, Evidence Required in Support of a Claim for Occupational Disease: This form is used by federal employees (and their physicians), supervisors, and compensation specialists to assist them by listing all the backing documentation needed to support an occupational disease claim.
• CA-5 - DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children: A deceased federal employee's widow, widower, and/or children may use this form to claim work-related death benefits.
• CA-5b - DFEC CA-5b, Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren: A deceased federal employee's parents, grandparents or representative (custodian or guardian) of minor brothers, sisters, or grandchildren may use this form to claim benefits.
• CA-6 - DFEC CA-6, Official Supervisor's Report of Employee's Death: This form is completed by a deceased employee's official superior or other authorized official of the employing agency when a Federal employee dies as a result of an employment related injury or disease.
• CA-7 - DFEC CA-7, Claim for Compensation: This form is used by a federal employee to to claim compensation for employment-related disability. The form must be filed with one's employing agency.
• CA-721 - 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.
• CA-722 - DFEC CA-722, Notice of Law Enforcement Officer's Death: This form is used to report the death of a law enforcement officer, including an attending physician's report. It may also be used to file a claim on behalf of a widow, widower, or children.
• CA-7a - DFEC CA-7a, Time Analysis Form: This form is used used for claiming compensation, including repurchase of paid leave.
• CA-7b - DFEC CA-7b, Leave Buy Back (LBB) Worksheet/Certification and Election: This form is intended to accompany Form CA-7, Claim for Compensation, when the employee is claiming leave buy back.