OWCP FORMS

CA1 - Notice of Traumatic Injury

This form is used to report a specific, one-time injury or accident that occurs during a single work shift, such as a slip, trip, or fall. It notifies the employer of the incident and initiates the workers' compensation process.

CA2 - Notice of Occupational Disease

This form is for reporting illnesses or injuries that develop over time due to workplace conditions or repeated exposures, like hearing loss, carpal tunnel syndrome, or respiratory issues. It begins the process of documenting an occupational disease claim.

CA2a - Notice of Recurrence

If a previous injury or illness worsens or reappears after the initial recovery, this form notifies the employer and Office of Workers' Compensation Programs (OWCP) of the recurrence. It may result in additional medical treatment or compensation.

CA7 - Claim for Compensation

This form is used to claim wage-loss compensation for lost work time due to a work-related injury or illness. It helps injured employees receive income replacement benefits.

CA7a - Time Analysis Form

The Time Analysis Form breaks down lost time by specific days and hours due to a work-related injury or illness. This detailed log supports compensation claims for partial or intermittent lost work time.

CA7b - Leave Buy Back

This form is used when employees want to repurchase leave used for a work-related injury, allowing them to convert sick or annual leave back to leave status once compensation is approved.

CA10 - What a Federal Employee Should Do When Injured at Work

This informational document outlines the steps employees should take after a workplace injury, including notifying supervisors, seeking medical attention, and filing the appropriate OWCP forms.

CA17 - Duty Status Report

A medical form completed by a physician, the CA-17 provides an employer with updates on an injured employee's work capabilities, restrictions, and expected recovery timeline. It helps in determining suitable work accommodations.

CA20 - Attending Physicians Report

The CA-20 is filled out by the treating physician and provides medical details about the injury or illness, including diagnosis, treatment, and prognosis. It is essential for validating the medical basis of the workers' compensation claim.

CA35 - Evidence Required in Support of Claim for Occupational Disease

This checklist guides employees on the necessary documentation and evidence required to support a claim for an occupational disease, ensuring all relevant information is submitted for review.

OWCP 5a - Work Capacity Evaluation

This form evaluates an employee's ability to work after a work-related psychiatric or psychological condition. It helps determine suitable work duties based on mental health status.

OWCP 5b - Work Capacity Evaluation

Similar to the OWCP-5a, this form is used to assess an employee’s work capabilities after a heart or lung condition related to the workplace. It aids in establishing appropriate work restrictions.

OWCP 5c - Work Capacity Evaluation

This evaluation assesses work capacity for employees with work-related musculoskeletal injuries (e.g., back, neck, or joint issues). It is used to help create a return-to-work plan with potential physical restrictions.

OWCP 915 - Claim for Medical Reimbursement

This form allows employees to claim reimbursement for medical expenses paid out of pocket for treatment related to a work injury. Receipts and documentation of the expenses must be included.

OWCP 957A - Medical Travel Refund Request

Employees use this form to claim reimbursement for travel expenses incurred when traveling to and from medical appointments related to their work injury or illness.

OWCP 957B - Medical Travel Refund Request

Similar to the OWCP-957A, this form is used to document and request reimbursement for additional or specific types of medical travel expenses related to OWCP-approved treatment.

CA-1122 - Short Form 3rd Party Recovery

If an employee's work injury or illness involves a third party, this form is used to report any compensation or recovery received from that third party, helping to offset the costs for OWCP.

CA-1108 - Long Form Recovery for 3rd Party Injuries

This form provides a comprehensive report of third-party recovery, including settlement details, when a third party is responsible for the work injury. It ensures OWCP is aware of any compensation from other sources.

FECA sf1199a - Direct Deposit Form

This form sets up direct deposit for federal workers' compensation payments, making it convenient for employees to receive compensation directly in their bank account.

PS Form 3971 - (USPS Only)

Specific to USPS employees, this form is used to document leave and absence related to a work injury, ensuring the leave is tracked accurately for compensation purposes.