Justification for No material/Nonsubstantive change for Authorization for Examination and/or Treatment (CA-16)

Justification - Authorization for Examination and or Treatment (CA-16).docx

Federal Employees' Compensation Act Medical Reports and Compensation Claims

Justification for No material/Nonsubstantive change for Authorization for Examination and/or Treatment (CA-16)

OMB: 1240-0046

Document [docx]
Download: docx | pdf

Justification for No material/Nonsubstantive Change

Authorization for Examination and/or Treatment (CA-16)

The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is the agency responsible for administration of the Federal Employees’ Compensation Act (FECA), 5 U.S.C. 8101 et. Seq. The statute provides for the payment of medical and wage loss and/or for permanent impairment to a scheduled member, arising out of work related injury or disease. The CA-16 is completed into two parts, Part A is completed authorization from the employing agency, and Part B. is a medical report completed by a physician who initially treats the injured worker. The form is required to be transmitted to OWCP, as indicated in item 11 of the form.


The current practice is that a copy of the form and medical documentation be returned to our central mailroom location in London, Kentucky. However, the central mailroom is changing address and we anticipate operations to begin by the middle of April 2020; therefore, approval of this request is needed by April 17, 2020 for posting of the form on the new medical bill processors web portal. This will allow ample time for the new bill processor’s assumption of operations on April 27, 2020.  Any approval date beyond would necessitate a delay in operations go-live until the request is approved.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSuggs, Anjanette C - OWCP
File Modified0000-00-00
File Created2021-01-13

© 2024 OMB.report | Privacy Policy