Justification for 1240-0046 (CA-7 only)

Justification for Non-Substantive Change, Form CA-7

The Office of Workers’ Compensation Programs (OWCP) Division of Federal Employees’ Compensation (DFEC) is requesting non-material changes to its CA-7 form (1240-0046), Claim for Compensation, which currently expires on 08/31/2026.

1. Removal of the option to claim a schedule award from Form CA-7 and removal of the form instructions related to schedule awards.

Injured workers currently use Form CA-7 to file claims for either disability or schedule award compensation. However, DFEC has recently created new Form CA-9 (1240-0064), Claim for Schedule Award, which the Office of Management and Budget approved, the expiration date is 10/31/2027. Injured workers will now use Form CA-9 to file a claim for Schedule Award instead of the CA-7 form. As such, DFEC is proposing to remove it from the CA-7 form.

Currently, a claim for schedule award is option d listed in page one, section two of the CA-7 form. DEFC proposes to remove this and the following on page three paragraph two: The form should also be submitted when the employee reaches maximum improvement and claims a schedule award. Additionally, on page three, under section number and explanation: “2d. Schedule Award” and “[s]chedule awards are paid for permanent impairment to a member or function of the body.”

Burden Change: Most claimants completing Form CA-7 for purposes of filing a schedule award claim are Federal employees. There is a small percentage that are not which represents the impact to the public. DFEC estimates that 775 individuals per year will no longer use Form CA-7 as the result of this change.

Based on DFEC’s experience with this form, it estimates that it took approximately 30 minutes (0.5 hours) for the completion of the form, including reading instructions and providing all requested information. Therefore, the estimated reduction in burden hours as the result of this change is 388 hours as noted below:

0.5 hours x 775 respondent forms = 387.5 hours, rounded up to 388 hours.

Because the wage category of most of the respondents is not known, we have estimated the cost of the burden hours using the National Average Weekly Wage for non-supervisory workers on private non-agriculture payrolls as computed by Bureau of Labor Statistics (BLS), or $27.06 per hour.¹

$27.06 x 388 hours = $10,499.28 respondent burden hour cost, or $10, 499 (rounded) which represents the reduced cost associated with this change.

Reference: https://www.bls.gov/web/empsit/ceseeb8a.htm.

Estimated Annualized Respondent Cost and Hour Burden

Activity	Number of Respondents	No. of Responses per Respondent	Total Responses	Average Burden (Hours)	Total Annual Burden (Hours)	Hourly Wage Rate*	Monetized Value of Respondent Time
Form CA-7	775	1	775	0.5	388	$27.06	$10, 499.00

As the new CA-9 form specifically addresses a claim for Schedule Award and to avoid any duplication with this new form and the current CA-7 form, DFEC is requesting a nonmaterial change to OMB No. 1240-0046 to remove the Schedule Award filing option. Included with this package are the paper and electronic versions of the proposed revised form.

2. Change Related to the Implementation of the Postal Services Health Benefit Program (PSHB)

In Section 10a, on page 2, DFEC is proposing a change to the question “Health Benefits under the FEHBP?” to “Health Benefits under the FEHBP or PSHB?”

The inclusion of “PSHB” is to incorporate the Office of Personnel Management’s change to health benefits coverage for employees of the United States Postal Service (USPS). USPS’ employees health benefits plans are changing to Postal Service Health Benefits (PSHB) plans effective January 1, 2025. The addition of “PSHB” will add clarity to ensure USPS staff submit information on the appropriate health benefit plan.

As the change impacts a component of Form CA-7 completed exclusively by Federal employees, there is no public burden impact.

1 This average hourly wage is based on the most recent non-preliminary data, March 2022.