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Federal forms, ICRs, and supporting documents

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 is listed under ICR 202502-1240-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form OWCP-5c Work Capacity Evaluation MusculoskeletalForm and Instruction
Form OWCP-5b Work Capacity Evaluation Cardiovascular/Pulmonary ConditionsForm and Instruction
Form OWCP-5a Work Capacity Evaluation Psychiatric/Psychological ConditionsForm and Instruction
Form CA-20 Attending Physicians ReportForm and Instruction
Form CA-17 Duty Status ReportForm 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 RequirmentsForm and Instruction
Form CA-1332 Outline for Otologic TestingForm and Instruction
Form CA-1305 Letter to doctor authorizing an eye exam with PPI ratingForm and Instruction
Form ca-16 Authorization for Examination and/or TreatmentForm and Instruction
Form CA-20 Attending Physicians ReportForm and Instruction
Form owcp-5c Work Capacity Evaluation Form, Musculoskeletal ConditionsForm and Instruction
Form owcp-5b Work Capacity Evaluation, Cardiovascular/Pulmonary ConditionsForm and Instruction
Form OWCP-5a Work Capacity Evaluation, Psychiatric/Psychological ConditionsForm and Instruction
Form CA-7 revised Claim for CompensationForm and Instruction
Employment and Earnings Table B-8b.bls. National Avg Hrly Earnings of Private Production Workers - not seasonal. Jan. 2026.pdfSupplementary Document
OPM RUS Salary Table 2026.pdfSupplementary Document
81 Fed. Reg 47418 (July 21, 2016).pdfSupplementary Document
Supporting Statement for 1240-0046 2026 OCIO1.clean copy.docxSupporting Statement A
FECA.pdfSupplementary 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

Historical document collections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