Appointments:
info@prctampa.com
MLK Location:
813 443 4742
Armenia Location:
813 304 1904

Download & Print

OWCP Workers' Compensation Forms

To help our patients with their Federal Workers' Compensation cases, we have assembled the necessary OWCP forms. These forms can be downloaded and printed for your own OWCP claim.

CA-1

Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation.

Download

CA-2

Notice of Occupational Disease and Claim for Compensation.

Download

CA-2a

Notice of Recurrence.

Download

CA-5

Claim for Compensation by Widow, Widower, and/or Children.

Download

CA-5b

Claim for Compensation by Parents, Brothers, Sisters, Grandparents, 
or Grandchildren.

Download

CA-6

Official Supervisor’s Report of Employee’s Death.

Download

CA-7

Claim for Compensation – Form CA-7 replaces ALL prior versions of CA-7 & CA-8 
(see FECA Bulletin No. 99-18).

Download

CA-7a

Time Analysis Form, used for claiming compensation, including repurchase 
of paid leave.

Download

CA-7b

Leave Buy Back (LBB) Worksheet/Certification and Election.

Download

CA-10

What a Federal Employee Should Do When Injured at Work.

Download

CA-12

Claim for Continuance of Compensation Under the Federal Employees’ 
Compensation Act.

Download

CA-17

Duty Status Report.

Download

CA-20

Attending Physician’s Report.

Download

CA-35

Evidence Required in Support of a Claim for Occupational Disease.

Download

CA-40

Designation of Recipient of FECA Death Gratuity Payment, under Section 1105 of 
Public Law 110-181 (Section 8102a).

Download

CA-41

Claim for Survivor Benefits Under the Federal Employees’ Compensation Act 
Section 8102a Death Gratuity.

Download

CA-42

Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death 
Gratuity.

Download

CA-278

Claim for Reimbursement of Benefit Payments and Claims Expense 
Under the War Hazards Compensation Act.

Download

CA-721

Notice of Law Enforcement Officer’s Injury Or Occupational Disease.

Download

CA-722

Notice of Law Enforcement Officer’s Death.

Download

CA-1031

Letter to Dependents to Verify Claimant Support.

Download

CA-1074

Letter to Parents in Death Claim Development.

Download

CA-1108

Statement of Recovery Letter with Long Form.

Download

CA-1122

Statement of Recovery Letter with Short Form.

Download

CA-2231

Claim for Reimbursement Assisted Reemployment.

Download

OWCP-5a

Work Capacity Evaluation Psychiatric/Psychological Conditions.

Download

OWCP-5b

Work Capacity Evaluation Cardiovascular/Pulmonary Conditions.

Download

OWCP-5c

Work Capacity Evaluation for Muscular Skeletal Conditions.

Download

OWCP-16

Rehabilitation Plan And Award.

Download

OWCP-17

Rehabilitation Maintenance Certificate.

Download

OWCP-20

Overpayment Recovery Questionnaire.

Download

OWCP-44

Rehabilitation Action Report.

Download

OWCP-04

Uniform Billing Form.

Download

OWCP-915

Claim For Medical Reimbursement Form OWCP-915 replaces CA-915.

Download

OWCP-957

Medical Travel Refund Request.

Download

Personal Rehabilitation in Tampa

It is important to seek a professional medical diagnosis and proper treatment right away to speed up healing and avoid any delays in benefits.
What do our patients say?

TESTIMONIALS

Personal Injury Rehabilitation Tampa
REIMAR SIERRA
Google verified review

"... En el plano profesional, con un staff envidiable hasta por Oprah Winfrey si un accidente has tenido..."

Khey Betancourt
Google verified review

"Excellent attention and professionalism with patients. Delighted with my visit. 100% recommended."

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Personal Rehabilitation Center

MLK Location
Armenia Location
Personal Rehabilitation Center MLK Location
Personal Rehabilitation Center Armenia Location

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    If you have been injured on the job or in an accident, don't wait. It is important to seek a professional medical diagnosis and proper treatment right away to speed up healing and avoid any delays in benefits. Call us today!

    © Copyright 2021 | Personal Rehabilitation Center, INC.

    © Copyright 2021 | Personal Rehabilitation Center, INC.

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