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  • Dol Ca-2a 2024

Get Dol Ca-2a 2024-2025

This form. OMB No. 1240-0009 Employing Agency (Supervisor or Compensation Specialist): Complete Part B. Expires: 01/31/2027 Note: Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Part A - Employee 2. Social Security Number 3. OWCP file number for original injury 1. Name of employee (Last, First, Middle Initial) 4. Date of Birth Mo./Day/Yr. 6. Home telephone 5. Sex Male Female 7. Home mailing address (include stre.

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Most work-related medical conditions fall into two categories: (1) traumatic injury (Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation), and (2) occupational disease (Form CA-2, Notice of Occupational Disease and Claim for Compensation).

CA-7a* Time Analysis Form, used for claiming compensation, including repurchase of paid leave.

Form CA-17 is designed to be filled out by the injured worker's supervisor and his/her treating physician to complete. It is split into two sections: A and B. Side A is to be completed by the employee's supervisor.

A CA-2a form is a claim for recurrence. If for instance an employee has an injured back and they go out of work for awhile and they're returned back to work, and then they have a worsening of that back injury condition, they would claim a recurrence. To do that they would file a form CA-2a.

CA-2 - Notice of Occupational Disease and Claim for Compensation. Use for occupational disease or illness claims - medical condition developed over more than one workday (i.e. carpal tunnel, skin disease). CA-2a - Federal Employee's Notice of Recurrence of Disability and Claim for Pay/Compensation.

This form is used by an employee to claim compensation in an established case for traumatic injury or occupational disease.

Fillable Forms Form NumberOWCP's Form Title / DescriptionCA-5*Claim for Compensation by Surviving Spouse and/or ChildrenCA-5b*Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildrenCA-6Official Supervisor's Report of Employee's DeathCA-7*Claim for Compensation37 more rows

CA-5. Subject. Claim for Compensation by Widow, Widower, and/or Children.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232