FECA Medical Report Forms, Claim for Compensation

Federal Employees' Compensation Act Medical Reports and Compensation Claims

OMB: 1240-0046

IC ID: 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