CA-7a, Time Analysis Form - nysalc: Fill out & sign online

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Click ‘Get Form’ to open the CA-7a, Time Analysis Form in our editor.
Begin by filling out Block 1 with your name (Last, First, Middle), followed by your Social Security Number in Block 2 and OWCP File Number in Block 3.
In Block 4, indicate the period covered by this form by entering the start and end dates. Ensure these match the dates on Forms CA-7 and CA-7b.
For Block 5, state the total hours claimed for leave without pay (LWOP) and any paid leave. Remember that this should be at least 10 hours unless it’s your final claim.
In Block 6, list each date in the first column. For each date, mark 'Y' if claiming compensation or 'N' if not in the second column. Fill out the remaining columns with hours worked and type of leave used.
Provide a reason for leave in the last column of Block 6. Ensure you have medical evidence for any claimed compensation.
Finally, sign and date the form before submitting it to the appropriate agency official for processing.

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How long do you have to file a CA7?

(2) The employee shall complete the front of Form CA-7 and submit the form to the employer for completion and transmission to OWCP. The form should be completed as soon as possible, but no more than 14 calendar days after the date pay stops due to the injury or disease.

How to file a CA-7 form?

Click on File a CA-7 and then continue on to the next step. Enter your case file number as well as other pertinent personal information including your injury date in order to access your case. Enter your SSN number carefully, and ensure that it matches with the one on file. Click on continue.

Who fills out CA-7?

Form CA-7 should be submitted by an injured worker (IW) every two weeks while disabled and in a LWOP status, unless the IW has been placed on the periodic roll. For traumatic injury cases, Form CA-7 should be completed before the end of the COP period, if disability will continue.

How to fill out a CA-7a form?

How to submit your Form CA-7: 1. If you are still employed at the agency where you were injured: Complete your portion of Form CA-7. Electronically file with PDFs of medical reports and/or documents. Paper: Give the CA-7 and documents, medical reports to your supervisor.

What is the CA-7a form?

Filing Form CA-7a, Time Analysis Form. When a form CA-7 is filed to claim compensation for intermittent dates, an accompanying form CA-7a should be filed to provide information on specific dates and hours of compensation claimed.

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What is a CA 7a form used to document?

General: This form is used when claiming FECA compensation, including repurchase of paid leave. It must be used when claiming compensation for more than one consecutive period of leave.

CA-7a, Time Analysis Form - nysalc 2026

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