Privacy Act System of Records

dol-govt-1 2020.pdf

Claim for Continuance of Compensation (CA-12)

Privacy Act System of Records

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Privacy Act Systems

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United States Department of Labor
Office of the Solicitor
Privacy Act Systems - DOL/GOVT-1
DOL/GOVT-1
SYSTEM NAME:
Office of Workers' Compensation Programs, Federal Employees' Compensation Act File.
SECURITY CLASSIFICATION:
Most files and data are unclassified. Files and data in certain cases have Top Secret
classification, but the rules concerning their maintenance and disclosure are determined by
the agency that has given the information the security classification of Top Secret.
SYSTEM LOCATION:
The central database for DOL/GOVT-1 is located at the DOL National office and the offices of
OWCP's contractor. Paper claim files are located at the various OWCP district offices; claim
files of employees of the Central Intelligence Agency are located at that agency. Copies of
claim forms and other documents arising out of a job-related injury that resulted in the filing
of a claim under the Federal Employees' Compensation Act (FECA) may also be maintained by
the employing agency (and where the forms were transmitted to OWCP electronically, the
original forms are maintained by the employing agency). In addition, records relating to thirdparty claims of FECA beneficiaries are maintained in the Division of Federal Employees' and
Energy Workers' Compensation, Office of the Solicitor, United States Department of Labor,
200 Constitution Avenue NW, Washington, DC 20210.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
Individuals and/or their survivors who file claims seeking benefits under FECA by reason of
injuries sustained while in the performance of duty. FECA applies to all civilian Federal
employees, including various classes of persons who provide or have provided personal
service to the Government of the United States, and to other persons as defined by law such
as State or local law enforcement officers, and their survivors, who were injured or killed while
assisting in the enforcement of Federal law. In addition, FECA covers employees of the Civil
Air Patrol, Peace Corps Volunteers, Job Corps students, Volunteers in Service to America,

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members of the National Teacher Corps, certain student employees, members of the Reserve
Officers Training Corps, certain former prisoners of war, and employees of particular
commissions and other agencies.
CATEGORIES OF RECORDS IN THE SYSTEM:
This system may contain the following kinds of records: Reports of injury by the employee
and/or employing agency; claim forms filed by or on behalf of injured Federal employees or
their survivors seeking benefits under FECA; forms authorizing medical care and treatment;
other medical records and reports; bills and other payment records; compensation payment
records; formal orders for or against the payment of benefits; transcripts of hearings
conducted; and any other medical, employment, or personal information submitted or
gathered in connection with the claim. The system may also contain information relating to
dates of birth, marriage, divorce, and death; notes of telephone conversations conducted in
connection with the claim; information relating to vocational and/or medical rehabilitation
plans and progress reports; records relating to court proceedings, insurance, banking and
employment; articles from newspapers and other publications;
information relating to other benefits (financial and otherwise) the claimant may be entitled
to; and information received from various investigative agencies concerning possible violations
of Federal civil or criminal law. The system may also contain information relating to certain
claims under the War Hazards Compensation Act (WHCA).
The system may also contain consumer credit reports on individuals indebted to the United
States, information relating to the debtor's assets, liabilities, income and expenses, personal
financial statements, correspondence to and from the debtor, information relating to the
location of the debtor, and other records and reports relating to the implementation of the
Federal Claims Collection Act (as amended), including investigative reports or administrative
review matters. Individual records listed here are included in a claim file only insofar as they
may be pertinent or applicable to the employee or beneficiary.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
5 U.S.C. 8101 et seq., 20 CFR 1.1 et seq.
PURPOSE(S):
FECA establishes the system for processing and adjudicating claims that Federal employees
and other covered individuals file with the Department's OWCP seeking monetary, medical
and similar benefits for injuries or deaths sustained while in the performance of duty. The
records maintained in this system are created as a result of and are necessary to this process.

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The records provide information and verification about the individual's employment-related
injury and the resulting disabilities and/or impairments, if any, on which decisions awarding or
denying benefits provided under the FECA must be based.
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING
CATEGORIES OF USERS AND THE PURPOSES OF SUCH USES:
In addition to those Department-wide routine uses set forth in the General Prefatory
Statement to this document, disclosure of information from this system of records may be
made to the following individuals and entities for the purposes noted when the purpose of the
disclosure is both relevant and necessary and is compatible with the purpose for which the
information was collected:
a. To any attorney or other representative of a FECA beneficiary for the purpose of assisting in
a claim or litigation against a third party or parties potentially liable to pay damages as a
result of the FECA beneficiary's FECA-covered injury and for the purpose of administering the
provisions of Sections 8131-8132 of FECA. Any such
third party, or a representative acting on that third party's behalf, may be provided
information or documents concerning the existence of a record and the amount and nature of
compensation paid to or on behalf of the FECA beneficiary for the purpose of assisting in the
resolution of the claim or litigation against that party or administering the provisions of
Sections 8131-8132 of FECA.
b. To Federal agencies that employed the claimant at the time of the occurrence or recurrence
of the injury or occupational illness in order to verify billing, to assist in administering FECA, to
answer questions about the status of the claim, to consider rehire, retention or other actions
the agency may be required to take with regard to the claim or to permit the agency to
evaluate its safety and health program. Disclosure to Federal agencies, including the
Department of Justice, may be made where OWCP determines that such disclosure is relevant
and necessary for the purpose of providing assistance in regard to asserting a defense based
upon FECA's exclusive remedy provision to an administrative claim or to litigation filed under
the Federal Tort Claims Act.
c. To other Federal agencies, other Government or private entities and to private-sector
employers as part of rehabilitation and other return-to-work programs and services available
through OWCP, where the entity is considering hiring the claimant or where otherwise
necessary as part of that return-to-work effort.
d. To Federal, State or private rehabilitation agencies and individuals to whom the claimant
has been referred for evaluation of rehabilitation and possible reemployment.

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e. To physicians, pharmacies, and other health care providers for their use in treating the
claimant, in conducting an examination or preparing an evaluation on behalf of OWCP and for
other purposes relating to the medical management of the claim, including evaluation of and
payment for charges for medical and related services and supplies.
f. To medical insurance or health and welfare plans (or their designees) that cover the
claimant in instances where OWCP has paid for treatment of a medical condition that is not
compensable under FECA, or where a medical insurance plan or health and welfare plan has
paid for treatment of a medical condition that may be compensable under FECA, for the
purpose of resolving the appropriate source of payment in such circumstances.
g. To labor unions and other voluntary employee associations from whom the claimant has
requested assistance for the purpose of providing such assistance to the claimant.
h. To a Federal, State or local agency for the purpose of obtaining information relevant to a
determination concerning initial or continuing eligibility for FECA benefits, and for a
determination concerning whether benefits have been or are being properly paid, including
whether dual benefits that are prohibited under any applicable Federal or State statute are
being paid; and for the purpose of utilizing salary offset and debt collection procedures,
including those actions required by the Debt Collection Act of 1982, to collect debts arising as
a result of overpayments of FECA compensation and debts otherwise related to the payment
of FECA benefits.
i. To the Internal Revenue Service (IRS) for the purpose of obtaining taxpayer mailing
addresses for the purposes of locating a taxpayer to collect, compromise, or write-off a
Federal claim against such taxpayer; and informing the IRS of the discharge of a debt owed
by an individual. Records from this system of records may be disclosed to the IRS for the
purpose of offsetting a Federal claim from any income tax refund that may be due to the
debtor.
j. To the Occupational Safety and Health Administration (OSHA) for purpose of using injury
reports filed by Federal agencies pursuant to FECA to fulfill agency injury reporting
requirements. Information in this system of records may be disclosed to OSHA by employing
agencies as part of any Management Information System established under OSHA regulations
to monitor health and safety.
k. To contractors providing services to the Department or any other Federal agency or any
other individual or entity specified in any of these routine uses or in the Department's General
Prefatory Statement who require the data to perform the services that they have contracted
to perform, provided that those services are consistent with the routine use for which the

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information was disclosed to the contracting entity. Should such a disclosure be made to the
contractor, the individual or entity making such disclosure shall ensure that the contractor
complies fully with all Privacy Act provisions, including those prohibiting unlawful disclosure of
such information.
l. To the Defense Manpower Data Center--Department of Defense and the United States
Postal Service to conduct computer matching programs for the purpose of identifying and
locating individuals who are receiving Federal salaries or benefit payments and are delinquent
in their repayment of debts owed to the United States under programs administered by the
Department in order to collect the debts under the provisions of the Debt Collection Act of
1982 (Pub. L. 97-365) by voluntary repayment, or by salary or administrative offset
procedures.
m. To a credit bureau for the purpose of obtaining consumer credit reports identifying the
assets, liabilities, expenses, and income of a debtor in order to ascertain the debtor's ability to
repay a debt incurred under FECA, to collect the debt, or to establish a payment schedule.
n. To consumer reporting agencies as defined by Sec. 603(f) of the Fair Credit Reporting Act
(15 U.S.C. 1681a(f)) or in accordance with Sec. 3(d)(4)(A)(ii) of the Federal Claims Collection
Act of 1966 as amended (31 U.S.C. 3711(f)) for the purpose of encouraging the repayment of
an overdue debt, the amount, status and history of overdue debts, the name and address,
taxpayer identification (SSN), and other information necessary to establish the identity of a
debtor, the agency and program under which the claim arose, may be disclosed pursuant to 5
U.S.C. 552a(b)(12).
o. To a Member of Congress or to a Congressional staff member in response to an inquiry
made by an individual seeking assistance who is the subject of the record being disclosed for
the purpose of providing such assistance.
p. To individuals, and their attorneys and other representatives, and Government agencies,
seeking to enforce a legal obligation on behalf of such individual or agency, to pay alimony
and/or child support for the purpose of enforcing such an obligation, pursuant to an order of a
State or local court of competent jurisdiction, including Indian tribal courts, within any State,
territory or possession of the United States, or the District of Columbia or to an order of a
State agency authorized to issue income withholding notices pursuant to State or local law or
pursuant to the requirements of Sec. 666(b) of title 42, U.S.C., or for the purpose of denying
the existence of funds subject to such legal obligation.

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q. To the National Institute for Occupational Safety and Health (NIOSH), for the purpose of
performing statistical analyses of injury and illness patterns to identify patterns and locations
of high incidence, help devise safety and return-to-work interventions, and guide worker
safety and health research. The statistical analyses performed by NIOSH will assist OWCP and
OSHA in their efforts to reduce the occurrence of employment injuries, assist employees in
achieving a smooth transition and return to work following employment injuries, and improve
Federal employee safety and health.
r. To the General Services Administration (GSA), for the purpose of permitting GSA and its
investigators to evaluate information about potential exposures to hazardous substances to
non-GSA federal employees in buildings or complexes managed by GSA.
s. To investigators in employing agency Offices of Inspector General, for the purpose of
assisting in the investigation of potential fraud by recipients of compensation benefits under
the FECA for their agencies, and for the purpose of assisting in evaluation of compliance by
employing agencies with timely filing requirements under the FECA and its implementing
regulations as well as for audits related to the employing agencies' handling of their portion of
the FECA claims process.
t. To a Federal, State or local agency charged with the responsibility for investigating
compliance with laws relating to health and safety, for the purpose of assisting such agency in
fulfilling its statutory or regulatory responsibilities.
u. For claims arising under 42 U.S.C. Sections 1701 and 1704 of the WHCA, to insurance
carriers or self-insured employers and their attorneys, for the purpose of assisting in
administering the claim, and for the purpose of verifying eligibility for payments to claimants
and reimbursements of amounts already paid.
Note: Disclosure of information contained in this system of records to the subject of the
record, a person who is duly authorized to act on his or her behalf, or to others to whom
disclosure is authorized by these routine uses, may be made over the telephone or by
electronic means. Disclosure over the telephone or by electronic means will only be done
where the requestor provides appropriate identifying information. Telephonic or electronic
disclosure of information is essential to permit efficient administration and adjudication of
claims under FECA. Pursuant to 5 U.S.C. 552a(b)(1), information from this system of records
may be disclosed to members and staff of the Employees' Compensation Appeals Board, the
Office of Administrative Law Judges, the Office of the Solicitor and other components of the
Department that have a need for the record in the performance of their duties.
DISCLOSURE TO CONSUMER REPORTING AGENCIES:

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The amount, status and history of overdue debts, the name and address, taxpayer
identification (SSN), and other information necessary to establish the identity of a debtor, the
agency and program under which the claim arose, may be disclosed pursuant to 5 U.S.C.
552a(b)(12) to consumer reporting agencies as defined by Sec. 603(f) of the Fair Credit
Reporting Act (15 U.S.C. 1681a(f)) or in accordance with Sec. 3(d)(4)(A)(ii) of the Federal
Claims Collection Act of 1966 as amended (31 U.S.C. 3711(f)) for the purpose of encouraging
the repayment of an overdue debt.
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
Files are stored electronically and/or on paper.
RETRIEVABILITY:
Files and automated data are retrieved after identification by coded file number and/or Social
Security Number which is cross-referenced to employee by name, employing establishment,
and date and nature of injury. Since the electronic case management files were created in
1975, these electronic files are located in District Offices that have jurisdiction over the claim,
and (as noted above under "System Location"), a complete central data base is maintained at
the location of the contractor. Prior to 1975, a paper index file was maintained; these records
were transferred to microfiche and are located in the national office.
SAFEGUARDS:
Access by authorized personnel only. Computer security safeguards are used for electronically
stored data and locked locations for paper files. Only personnel having an appropriate security
clearance may handle or process security files.
RETENTION AND DISPOSAL:
All case files and automated data pertaining to a claim are destroyed 15 years after the case
file has become inactive. Case files that have been scanned to create electronic copies are
destroyed after the copies are verified. Electronic data is retained in its most current form
only, and as information is updated, outdated information is deleted. Some related financial
records are retained only in electronic form, and destroyed six years and three months after
creation or receipt.
SYSTEM MANAGER(S) AND ADDRESS:

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Director for Federal Employees' Compensation, Office of Workers' Compensation Programs,
200 Constitution Avenue NW, Washington, DC 20210.
NOTIFICATION PROCEDURE:
An individual wishing to inquire whether this system of records contains information about
him/her may write or telephone the OWCP district office that services the state in which the
individual resided or worked at the time he or she believes a claim was filed. In order for the
record to be located, the individual must provide his or her full name, OWCP claim number (if
known), date of injury (if known), and date of birth.
RECORD ACCESS PROCEDURES:
Any individual seeking access to non-exempt information about a case in which he/she is a
party in interest may write or telephone the OWCP district office where the case is located, or
the systems manager, and arrangements will be made to provide review of the file. Access to
copies of documents maintained by the employing agency may be secured by contacting that
agency's designated disclosure officials.
CONTESTING RECORD PROCEDURES:
Specific materials in this system have been exempted from certain Privacy Act provisions
regarding the amendment of records. The section of this notice entitled "Systems exempted
from certain provisions of the Act," indicates the kind of materials exempted, and the reasons
for exempting them. Any individual requesting amendment of non-exempt records should
contact the appropriate OWCP district office, or the system manager. Individuals requesting
amendment of records must comply with the Department's Privacy Act regulations at 29 CFR
71.1 and 71.9, and with the regulations found at 20 CFR 10.12.
RECORD SOURCE CATEGORIES:
Information contained in this system is obtained from injured employees; beneficiaries;
employing Federal agencies; other Federal agencies; physicians; hospitals; clinics; suppliers of
health care products and services and their agents and representatives; educational
institutions; attorneys; Members of Congress; OWCP field investigations; State governments;
consumer credit reports; agency investigative reports; correspondence with the debtor
including personal financial statements; records relating to hearings on the debt; and other
Department systems of records.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:

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In accordance with 5 U.S.C. 552a(k)(2), investigative material in this system of records
compiled for law enforcement purposes is exempt from subsections (c)(3), (d), (e)(1), (e)(4)
(G), (H) and (I), and (f) of 5 U.S.C. 552a, provided, however, that if any individual is denied
any right, privilege, or benefit that he or she would otherwise be entitled to by Federal law, or
for which he or she would otherwise be eligible, as a result of the maintenance of these
records, such material shall be provided to the individual, except to the extent that
the disclosure of the material would reveal the identity of a source who furnished information
to the Government under an express promise that the identity of the source would be held in
confidence, or prior to January 1, 1975, under an implied promise that the identity of the
source would be held in confidence.
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