icon-lock Patient Portal

DOL Forms

To better assist you in filing your federal workers compensation claim, we have provided links below to several helpful forms. You can download these forms to your computer and then print them. 

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

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

Form CA-2a. Notice of Recurrence

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

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

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

Form CA-12. Claim For Continuance of Compensation Under the Federal Employees’ Compensation Act

Form CA-16.  Authorization for examination and/or treatment. This form is only available to authorized employee agency personnel, and may be obtained in electronic format via the agency query system (AQS) or ECOMP, or by contacting the employment agency workers compensation personnel. 

Form CA-17. Duty Status Report

Form CA-20. Attending Physician’s Report 

pwp-shape-1
pwp-shape-2