OMB control number
Notice of Peace Corps Volunteer Authorization for Examination and/or Treatment
OMB 1240-0059 · DOL/OWCP.
OMB 1240-0059
OWCP administers the Federal Employees' Compensation Act (FECA). A Peace Corps Volunteer who sustains an injury or contracts an illness overseas while in Peace Corps service may be entitled to benefits under the FECA. DOL authorizes the Peace Corps to furnish medical benefits to a volunteer, who is injured during the volunteer’s period of service, for a period of 120 days following termination if the service volunteer’s injury meets requirements.
The latest form for Notice of Peace Corps Volunteer Authorization for Examination and/or Treatment expires 2028-12-31 and is listed under ICR 202505-1240-004.
Latest Forms, Documents, and Supporting Material
Form CA-15 Peace Corps Volunteer Authorization for Examination And/Or Treatment
Supporting Statement for 1240-0059 Peace Corps Volunteer Auth for Exam and or Treatment (CA-15) - 11-19-2025.docx
BLS Occupational Employment and Wages.html 
Peace Corps Volunteer Authorization for Examination and/or TreatmentAll Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202505-1240-004 | Extension without change of a currently approved collection | 2025-11-13 | ||
| 202405-1240-004 | Revision of a currently approved collection | 2025-08-06 | ||
| 202212-1240-002 | Extension without change of a currently approved collection | 2023-01-23 | Approved with change | |
| 202207-1240-006 | No material or nonsubstantive change to a currently approved collection | 2022-07-27 | Approved without change | |
| 202008-1240-037 | No material or nonsubstantive change to a currently approved collection | 2020-10-20 | Approved without change | |
| 201907-1240-002 | New collection (Request for a new OMB Control Number) | 2020-01-22 | Approved without change |