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Instructions:
What
A Federal Employee Should Do When Injured at Work (CA-10)
When
Injured At Work Information Guide for Federal Employees (CA-11)
Injury
Compensation for Federal Employees (CA-810)
Forms:
CA-1
(Federal Employee's Notice of Traumatic Injury and Claim for
Continuance of Pay / Compensation), CA-2 (Notice of Occupational
Disease and Claim for Compensation), and CA-2a (Notice of
Recurrence) are now done on the CBP intranet
CA-5a
(Claim for Compensation by Widow, Widower, and/or Children)
CA-5b
(Claim for Compensation by Parents, Brothers, Sisters, Grandparents,
or Grandchildren)
CA-6
(Official Superior's Report of Employee's Death)
CA-7
(Claim for Compensation)
CA-7a
(Time Analysis Form)
CA-7b
(Leave Buy Back (LBB) Worksheet / Certification and Election)
CA-12
(Claim for Continuance of Compensation under the Federal Employees'
Compensation Act)
CA-17
(Duty Status Report)
CA-20
(Attending Physician's Report)
CA-35
(Evidence Required in Support of a Claim for Occupational
Disease)
CA-915
(Claim for Medical Reimbursement)
OWCP-5a
(Work Capacity Evaluation Psychiatric / Psychological Conditions)
OWCP-5b
(Work Capacity Evaluation Cardiovascular / Pulmonary Conditions)
OWCP-5c
(Work Capacity Evaluation Musculoskeletal Conditions)
Addresses:
U.S.
Department of Labor
District Office 13 – San Francisco
(Arizona, California, Hawaii, and Nevada)
Andy Tharp, District Director
(415) 625-7500
U.S. Dept. of Labor, OWCP
90 Seventh St., Suite 15300
San Francisco, CA 94103
(415) 625-7500
Fax: (415) 625-7450
-OWCP has a toll-free automated system that provides information
regarding specific claims. By calling 866-OWCP-IVR (866-692-7487),
injured workers and their representatives may access information
regarding case status and compensation payments. Injured workers
should have their 9-digit case file or claim number and social
security number when calling.
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