Federal Employees Program
OWCP's Federal Employees Program has made a variety of forms available online. These forms are only available in PDF format. In order to view and/or print PDF documents you must have a PDF viewer. It is highly recommended that you have the most current version (click on Adobe Acrobat Reader to download the current version) available on your workstation. These forms can be viewed in an Internet Explorer browser window, but not in other browsers. If you are using Chrome or Firefox, follow these instructions to download PDF files and open them in Adobe Acrobat Reader.
The forms in the list below may be completed manually via the print form option or electronically via the electronic fill option:
Printable Forms
All of the Federal Employees Program's online forms (with the exception of Forms CA-16, CA-26 and CA-27) are available to print and to manually fill and submit. Simply click on the appropriate form and print it using the [Print] button provided near the top of the form. Write or type the required information on the hardcopy and authorize the form, if applicable, with a hand-written signature. Then mail or fax the completed form to the Federal Employees Program office you normally send to for this process.
Fillable Forms
Forms noted with an asterisk (*) may be electronically filled. Simply click on the appropriate form, fill out the form using your computer keyboard and the <TAB> key or your mouse to navigate between form fields. Print the form (use the Print button on or near the top of the form), authorize the form (if applicable provide hand-written signature) and mail or fax the completed form to the Federal Employees Program office you normally send to for this process.
Please contact your agency if you have questions about filling these forms or need other forms. You can also use Contact Us to reach your agency for assistance.
NOTE: When printing these files please remember to use the Adobe Acrobat Reader print icon or the [Print] button on the form, itself, and NOT your browser's print icon on the browser toolbar.
Questions? Please visit the Federal Employees Program’s Frequently Asked Questions page.
Form Number |
OWCP's Form Title / Description |
---|---|
CA-1* |
Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation |
CA-2* |
Notice of Occupational Disease and Claim for Compensation |
Notice of Recurrence |
|
CA-5* |
Claim for Compensation by Surviving Spouse and/or Children |
Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren |
|
Official Supervisor's Report of Employee's Death |
|
CA-7* |
Claim for Compensation |
Time Analysis Form, used for claiming compensation, including repurchase of paid leave |
|
Leave Buy Back (LBB) Worksheet/Certification and Election |
|
Claim For Continuance of Compensation Under the Federal Employees' Compensation Act |
|
CA-16 |
Authorization for Examination and/or Treatment This form is only available to authorized employing agency personnel, and may be obtained in electronic format via the Agency Query System (AQS) or ECOMP, or by contacting the employing agency workers’ compensation personnel. |
Duty Status Report |
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Attending Physician's Report |
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Authorization Request Form and Certification/Letter of Medical Necessity for Compounded Drugs This form is only available to registered medical providers by logging into the OWCP Web Bill Portal. To submit the form, providers must click on the 'Provider' Link to the right of the FECA oval located at the top left of the home page, login with their user ID and password, and then click on the 'LMN Documents' link located in the left menu bar. For providers not yet registered, after clicking the 'Provider' link, click the 'Web Registration' link located in the left menu bar to register for web access. For providers not yet enrolled, click on 'Forms & Links' in the horizontal menu at the top of the home page to download the Provider Enrollment form and instructions. |
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Authorization Request Form and Certification/Letter of Medical Necessity for Opioid Medications This form is only available to registered medical providers by logging into the OWCP Web Bill Portal. To submit the form, providers must click on the 'Provider' Link to the right of the FECA oval located at the top left of the home page, login with their user ID and password, and then click on the 'LMN Documents' link located in the left menu bar. For providers not yet registered, after clicking the 'Provider' link, click the 'Web Registration' link located in the left menu bar to register for web access. For providers not yet enrolled, click on 'Forms & Links' in the horizontal menu at the top of the home page to download the Provider Enrollment form and instructions. |
|
Evidence Required in Support of a Claim for Occupational Disease |
|
Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a |
|
Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity |
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Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity |
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Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act |
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Notice of Law Enforcement Officer's Injury Or Occupational Disease |
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Notice of Law Enforcement Officer's Death |
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Letter to Dependants to Verify Claimant Support |
|
Letter to Parents in Death Claim Development |
|
Statement of Recovery Letter with Long Form |
|
Statement of Recovery Letter with Short Form |
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Claim for Reimbursement Assisted Reemployment |
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Work Capacity Evaluation Psychiatric/Psychological Conditions |
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Work Capacity Evaluation Cardiovascular/Pulmonary Conditions |
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Work Capacity Evaluation for Musculoskeletal Conditions |
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Rehabilitation Plan And Award |
|
Rehabilitation Maintenance Certificate |
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Overpayment Recovery Questionnaire |
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Rehabilitation Action Report |
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Uniform Billing Form |
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Claim For Medical Reimbursement Form OWCP-915 replaces CA-915 |
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Medical Travel Refund Request |
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Provider Enrollment form |
|
Health Insurance Claim Form |
|
Direct Deposit Sign-Up Form |