General information on filing Worker's Compensation claims

Worker's Compensation Forms

All are PDF, each one opens a new window

CA-1 Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation

CA-2 Notice of Occupational Disease and Claim for Compensation

CA-2a Notice of Recurrence

CA-5 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-16 Authorization for Examination And/Or Treatment

CA-17 Duty Status Report

CA-20 Attending Physician's Report

CA-35h Evidence Required in Support of a Claim for Work-Related Carpel Syndrome

CA-915 Claimant Medical Reimbursement Form

HCFA-1450 (UB-92) Uniform Bill

SSA-516 SSA Accident/Occupational Illness Report

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