NOTICE TO REVIEWER
Date: May 9, 2023
Request Type: Non-substantive Change
Employing Agency: Office of Workers’ Compensation Programs/Division of Federal Employees’ , Longshore and Harbor Workers’ Compensation (DFELHWC)
Form Number/Name: CA-1032, Request for Information on Earnings, Dual Benefits, Dependents and Third-Party Settlements
OMB Control Number/Expiration Date: 1240-0016, November 30, 2023
Justification: DFELHWC is seeking approval for the electronic version of the CA-1032 (see attached sample print screen shots) for electronic filing and submission via the Employee Compensation Operations and Management Portal, known as ECOMP. This new interface will allow a claimant to complete the form electronically via ECOMP.
Currently, this form is generated by OWCP in paper format and sent to a claimant for completion. The options available for return of the completed form is via mail or uploading in the ECOMP.
The CA-1032 that is currently OMB approved has not changed.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Sharpless, Marcus J - OWCP |
| File Modified | 0000-00-00 |
| File Created | 2023-08-28 |