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PROCEDURES
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)
CA-2a
(Notice of Recurrence)
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 & PHONE NUMBERS
U.S. Department of Labor
District 16 (Dallas) Division of Federal Employee's Compensation
(DFEC)
Phone: (972) 850-2300 M-F 8a-4:30 pm
Fax: (972) 850-2301
Send medical reports, bills and case correspondence to the central
mail processing facility at the following address:
U.S. Department of Labor
DFEC Central Mailroom - District 16
P.O. Box 8300
London, KY 40742-8300
All correspondence and receipts sent in connection with claims
should be on letter-size paper and should show
claimant's name and case file number on each page.
Send Claim Forms (CA-1, CA-2, CA-5, CA-7, and CA-16's) and any
attachments directly to the following District Office:
U.S. Department of Labor
Employment Standards Administration
Office of Worker's Compensation Programs
525 S. Griffin St., Rm 100
Dallas, TX 75202 |
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