Justification Statement for Non-material change.CA721

Justification Statement for Non-material change.CA721.docx

Notice of Law Enforcement Officer's Injury or Occupational Disease and Notice of Law Enforcement Officer's Death

OMB: 1240-0022

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Justification for No material/Non-substantive Change

Notice of Law Enforcement Officer’s Injury or Occupational Disease (CA-721)


The Office of Workers' Compensation Programs (OWCP) administers the Federal Employees' Compensation Act (FECA), 5 U.S.C. 8101 and 5 U.S.C. 8191 et seq. The statute provides for the filing of claims for compensation for injury to non-Federal law enforcement offices under the provisions of 5 U.S.C. 8191 et seq. The other forms in this clearance provide the basic information needed to process the claims made for injury or death.

With regards to the form itself, OWCP requests an address be revised on page 6 of the form which requires that the completed form be sent to OWCP. The address currently notes OWCP, Dist Office 9, Cleveland. 1240 East Ninth Street, Room 851, Cleveland, Ohio 44199. Due to the consolidation of the Division of Federal Compensation (DFEC) and the Longshore and Harbor Worker’s Compensation Programs (LHWC), which took effect in 2020, the new Division is now noted as OWCP Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC). The address on page 6 should now be noted as Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation, Federal Employees' Compensation Act, (OWCP/DFELHWC-FECA), PO Box 8311, London, KY 4072-8311.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorHamai, Pamela A - OWCP
File Modified0000-00-00
File Created2022-08-05

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