OWCP-44 Rehabilitation Action REport

Rehabilitation Action Report

Reset

Print

U.S. Department of Labor

Office of Workers' Compensation Programs

The OWCP-44 is used by contractors hired by OWCP to provide vocational rehabilitation services to injured workers. OMB No. 1240-0008
Expires: 05/31/2024
The form is submitted to OWCP to provide prompt notification of key events that may require OWCP action in the
vocational rehabilitation or claims adjudication process. The information collected will be handled and stored in
compliance with the Freedom of Information Act and the Privacy Act of 1974.
1. Name of Injured Worker (Last, First, Middle Initial)

2. OWCP File Number

3. Current Rehabilitation Status

4. Date Rehabilitation Status Began

5. Action Item (Documents describing each item are attached or complete information regarding each item is provided under #6)
Claimant Obstruction: claimant does not appear at scheduled meetings, fails
to carry out agreed upon actions, etc.

Job Offered, Description Attached
Job Accepted / RTW

Request for Status Extension

Job Refused

Request for Status Change

Change in Medical Status

Voc Testing Request: (Information for OWCP-24 provided below)

Waiver of Testing Request (justification below)

Review for Possible Case Closure

VR Plan Submitted for Review
ATTENTION FECA RCs – Please remember to send an email alert to the managing RS when this OWCP-44 is uploaded to file.
ATTENTION FECA CEs - This form is a primary communication from the RC to the FECA RS. Any claims actions must be coordinated
with the managing RS.
* These alerts do not apply to the Longshore program.
6. Comments

7. Rehabilitation Counselor's Name (Last, First, Middle Initial)

RC Email Address

8. Date

Telephone Number

9. List any attachments to this form

OWCP-44 (Rev. 05-14)

PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you are hereby notified that: (1) The Federal
Employees' Compensation Act (FECA), as amended and extended (5 U.S.C. 8101, et seq. and the Longshore and
Harbor Worker's Compensation Programs (LHWCA) as amended and extended (33 U.S.C. 901 et. Seq) of the U.S.
Department of Labor, are administered by the Office of Workers' Compensation Programs of the U.S. Department of
Labor, which receives and maintains personal information on claimants and their immediate families. (2) Information
which the Office has will be used to determine eligibility for and the amount of benefits payable under the FECA and
LHWCA , and may be verified through computer matches or other appropriate means. (3) Information may be given to
the Federal agency which employed the claimant at the time of injury in order to verify statements made, answer
questions concerning the status of the claim, verify billing, and to consider issues relating to retention, rehire, or other
relevant matters. (4) Information may be given to Federal, state and local agencies for law enforcement purposes, to
obtain information relevant to a decision under the FECA and LHWCA to determine whether benefits are being paid
properly, including whether prohibited dual payments are being made, and, where appropriate, to pursue salary/
administrative offset and debt collection actions required or permitted by the FECA and LHWCA and/or the Debt
Collection Act. (5) Failure to disclose all requested information may delay the processing of the claim or the payment of
benefits, or may result in an unfavorable decision or reduced level of benefits.

PUBLIC BURDEN STATEMENT
According to the Paper Reduction Act of 1995, no persons are required to respond to this collection of information unless
it displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to
average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond
to this collection is required to obtain a benefit (5 U.S.C. 8101 and 33 U. S. C. 901). Send comments regarding the
burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to the
Office of Workers' Compensation Programs, Department of Labor, Room S-3229, 200 Constitution Avenue, N.W.
Washington, D.C. 20210, and reference the OMB Control Number 1240-0008. Note: please do not send the completed
form to this office.

ACCOMMODATION STATEMENT
If you have a disability and are in need of communication assistance (such as alternate formats or sign language
interpretation), accommodations and/or modifications, please contact OWCP.

OWCP-44 PAGE 2 (Rev. 05-14)