Form Number

OWCP's Form Title / Description

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

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

Form CA-7 replaces ALL prior versions of CA-7 & CA-8 (see FECA Bulletin No. 99-18)

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

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

OWCP-5a*

Work Capacity Evaluation Psychiatric/Psychological Conditions

OWCP-5b*

Work Capacity Evaluation Cardiovascular/Pulmonary Conditions

OWCP-5c*

Work Capacity Evaluation for Musculoskeletal Conditions

OWCP-16*

Rehabilitation Plan And Award

OWCP-17*

Rehabilitation Maintenance Certificate

OWCP-20*

Overpayment Recovery Questionnaire

OWCP-44*

Rehabilitation Action Report

OWCP-04

Uniform Billing Form

OWCP-915*

Claim For Medical Reimbursement

Form OWCP-915 replaces CA-915

OWCP-957*

Medical Travel Refund Request

OWCP-1168

Provider Enrollment form

OWCP-1500*

Health Insurance Claim Form

HCFA-1500*

Health Insurance Claim Form

SF1199A

Direct Deposit Sign-Up Form