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Click ‘Get Form’ to open the CA-7 form in the editor.
Begin with Section 1 by entering your name, mailing address, and OWCP file number. Ensure all details are accurate for effective communication.
In Section 2, specify the type of compensation you are claiming. Indicate if it is for leave without pay, leave buy back, or other wage loss. Be clear about the inclusive date range.
Proceed to Section 3 to report any earnings from outside employment during the claimed period. This includes self-employment and any odd jobs.
In Section 4, indicate whether this is your first CA-7 claim for compensation related to this injury. Follow the instructions based on your response.
Complete Sections 5 through 7 as necessary, providing information about dependents and any support payments made.
Finally, review all sections for accuracy before signing and dating the form at the end. Submit it through our platform for processing.
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20 CFR 10.102 - How and when is a claim for wage loss
(a) Form CA-7 is used to claim compensation for periods of disability not covered by COP. (1) An employee who is disabled with loss of pay for more thanRead more
The form should also be submitted when the employee DocHubes maximum improvement and claims a schedule award. If the employee is receiving continuation of payRead more
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