OMB control number

Federal Employees' Compensation Act Medical Reports and Compensation Claims

OMB 1240-0046 · DOL/OWCP.

OMB 1240-0046

These forms are used for filing claims for wage loss 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).

The latest form for Federal Employees' Compensation Act Medical Reports and Compensation Claims expires 2026-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form OWCP-5c Work Capacity Evaluation Musculoskeletal Form and Instruction
Form OWCP-5b Work Capacity Evaluation Cardiovascular/Pulmonary Conditions Form and Instruction
Form OWCP-5a Work Capacity Evaluation Psychiatric/Psychological Conditions Form and Instruction
Form CA-20 Attending Physicians Report Form and Instruction
Form CA-17 Duty Status Report Form and Instruction
Form CA-1090 Claimant Request for Attendant Services (CA-1090) Form and Instruction
Form CA-1331 with CA-10 Authorization to Doctor for Audiologic and Otologic Evaluation OWCP Hearing Loss Requirments Form and Instruction
Form CA-1332 Outline for Otologic Testing Form and Instruction
Form CA-1305 Letter to doctor authorizing an eye exam with PPI rating Form and Instruction
Form ca-16 Authorization for Examination and/or Treatment Form and Instruction
Form CA-20 Attending Physicians Report Form and Instruction
Form owcp-5c Work Capacity Evaluation Form, Musculoskeletal Conditions Form and Instruction
Form owcp-5b Work Capacity Evaluation, Cardiovascular/Pulmonary Conditions Form and Instruction
Form OWCP-5a Work Capacity Evaluation, Psychiatric/Psychological Conditions Form and Instruction
Form CA-7 revised Claim for Compensation Form and Instruction
Employment and Earnings Table B-8b.bls. National Avg Hrly Earnings of Private Production Workers - not seasonal. Jan. 2026.pdf Supplementary Document
OPM RUS Salary Table 2026.pdf Supplementary Document
81 Fed. Reg 47418 (July 21, 2016).pdf Supplementary Document
Supporting Statement for 1240-0046 2026 OCIO1.clean copy.docx Supporting Statement A
FECA.pdf Supplementary Document
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction

All Historical Document Collections

202605-1240-001	Extension without change of a currently approved collection	2026-06-04
202502-1240-001	No material or nonsubstantive change to a currently approved collection	2025-02-19
202412-1240-001	No material or nonsubstantive change to a currently approved collection	2024-12-05
202407-1240-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-08-20
202303-1240-001 Approved without change	Revision of a currently approved collection	2023-07-11
202206-1240-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2022-06-24
202101-1240-003 Approved without change	Extension without change of a currently approved collection	2021-02-24
202008-1240-067 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-10-22
202003-1240-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-04-12
202002-1240-018 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-02-25
201811-1240-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-11-14
201701-1240-002 Approved with change	Revision of a currently approved collection	2017-11-24
201602-1240-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-03-21
201406-1240-002 Approved without change	Revision of a currently approved collection	2014-10-31
201204-1240-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-04-30
201104-1240-001 Approved without change	Revision of a currently approved collection	2011-09-23
201003-1240-046 Approved without change	Extension without change of a currently approved collection	2010-03-12