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FECA Medical Report Forms, Claim for Compensation
Federal Employees' Compensation Act Medical Reports and Compensation Claims
OMB: 1240-0046
IC ID: 13770
OMB.report
DOL/OWCP
OMB 1240-0046
ICR 202407-1240-001
IC 13770
( )
Documents and Forms
Document Name
Document Type
Form CA-7
FECA Medical Report Forms, Claim for Compensation
Form and Instruction
Form CA-7
FECA Medical Report Forms, Claim for Compensation
Form and Instruction
CA-7 Claim for Compensation
ca-7.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Form and Instruction
CA-17 Duty Status Report
ca-17.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Form and Instruction
OWCP-5a Work Capacity Evaluation, Psychiatric/Psychological Conditions
OWCP-5a.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Form and Instruction
owcp-5b Work Capacity Evaluation, Cardiovascular/Pulmonary Conditions
OWCP-5b.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Form and Instruction
owcp-5c Work Capacity Evaluation Form, Musculoskeletal Conditions
OWCP-5c.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm ca-5c.pdf
Form and Instruction
CA-20 Attending Physicians Report
ca-20.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Form and Instruction
ca-16 Authorization for Examination and/or Treatment
CA-16 final.pdf
www.dol.gov/agencies/owcp/FECA/regs/compliance/forms.
Form and Instruction
CA-1305 Letter to doctor authorizing an eye exam with PPI rating
CA-1305.rtf
Form and Instruction
CA-1332 Outline for Otologic Testing
CA-1332 final.rtf
Form and Instruction
CA-1331 with CA-1087 enclosure Authorization to Doctor for Audiologic and Otologic Evaluation OWCP Hearing Loss Requirments
CA-1331 final.pdf
Form and Instruction
CA-1090 Claimant Request for Attendant Services (CA-1090)
Claimant Request for Attendant Services.docx
Form and Instruction
CA-17 Duty Status Report
ca-17_ES.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Form and Instruction
CA-20 Attending Physicians Report
ca-20_ES.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Form and Instruction
OWCP-5a Work Capacity Evaluation Psychiatric/Psychological Conditions
owcp-5a_ES.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Form and Instruction
OWCP-5b Work Capacity Evaluation Cardiovascular/Pulmonary Conditions
owcp-5b_ES.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Form and Instruction
OWCP-5c Work Capacity Evaluation Musculoskeletal
owcp-5c_ES.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm ca-5c.pdf
Form and Instruction
Information Collection (IC) Details
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