OMB control number
Notice of Recurrence
OMB 1240-0009 ยท DOL/OWCP.
OMB 1240-0009
This form is used by current, or occasionally former, Federal employees to claim wage loss or medical treatment resulting from a recurrence of a work-related injury while Federally employed. The information is necessary to ensure the accurate payment of benefits.
The latest form for Notice of Recurrence expires 2027-01-31 and is listed under ICR 202310-1240-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CA-2a Notice of Recurrence | Form and Instruction |
| National Average Weekly Wage for non-supervisory workers on private non-agriculture pay rolls as computed by BLS as of Aug 2023.pdf | Supplementary Document |
| 60 day FRN 8.7.23.pdf | Supplementary Document |
 Privacy Act System of Records - FEC.docx | Supplementary Document |
| Section 8149 for CA-2a 2023.docx | Supplementary Document |
| dol govt - 1.pdf | Supplementary Document |
| 20 CFR 10.104 Supplemental Documentation.pdf | Supplementary Document |
| OPM Salary Table 2023. RUS.pdf | Supplementary Document |
| 1240-0009 Supporting Statement_2023_MN_Clean version.docx | Supporting Statement A |
 Notice of Recurrence |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202310-1240-002 | Revision of a currently approved collection | 2023-12-06 | Approved without change | |
| 202005-1240-006 | Extension without change of a currently approved collection | 2020-10-30 | ||
| 201703-1240-006 | Revision of a currently approved collection | 2017-08-31 | Approved without change | |
| 201401-1240-001 | Revision of a currently approved collection | 2014-06-25 | Approved without change | |
| 201101-1240-001 | Revision of a currently approved collection | 2011-05-02 | Approved without change | |
| 201003-1240-009 | Extension without change of a currently approved collection | 2010-03-12 | Approved without change |