Federal Employees' Compensation Act Medical Reports and Compensation Claims

OMB 1240-0046

OMB 1240-0046

Address change for the Attending Physician's Report (CA-20), Authorization to Doctor for Audiologic and Otologic Evaluation OWCP Hearing (CA-1331), Claimant Request for Attending Physician (CA-1090) and Instructions (CA-1305). These forms are used for filing claims for wage loss or permanent impairment due to a Federal employment-related injury, and to obtain necessary medical documentation to determine whether a claimant is entitled to benefits under the Federal Employees Compensation Act (FECA), 5 U.S.C. 8101 et.seq.

The latest form for Federal Employees' Compensation Act Medical Reports and Compensation Claims expires 2021-03-31 and can be found here.


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