DOL-ESA Forms ca-2a 2026

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The document is a Claim for Reimbursement form from the U.S. Department of Labor's Office of Workers' Compensation Programs, intended for employers to report details about a claimant's employment and earnings to facilitate reimbursement under the Assisted Reemployment program. It includes instructions for completion, privacy information regarding personal data handling, and a public burden statement related to the information collection process.

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Click ‘Get Form’ to open the DOL-ESA Forms ca-2a in the editor.
Begin by filling out Section 1 with the Employer's Name, Phone Number, and Complete Mailing Address. Ensure all details are accurate for effective communication.
In Section 4, enter the Employer's Tax I.D. Number and Bill Payment Number. This information is crucial for processing your claim.
Proceed to Section 6 to input the Claimant's Name and OWCP File Number. Make sure to include both last and first names for clarity.
Complete Sections 9 through 13 by providing employment dates, hours worked, pay rate per hour, total amount earned, and amount of reimbursement claimed.
If applicable, have the Claimant sign in Section 8. If unsigned, provide an explanation in the comments section as instructed.
Finally, ensure that a Supervisor signs in Section 14 and includes the date before submitting the form.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (72 Votes)
2010	4 Satisfied (59 Votes)

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What is a CA16 form?

The employee should carefully follow the instructions attached to Forms CA-1 and CA-2. Form CA-1 should be filed within 30 days of the injury, and Form CA-2 should be filed within 30 days of the date the employee realized the disease or illness was caused or aggravated by the employment.

What is the most common injury claim on Workmans Comp?

Typical Workers Compensation Injuries According to OSHA and the National Safety Council (NSC), some of the most common include: Muscle sprains, strains, and tears. Bone fractures. Cuts, lacerations, and punctures.

What is CA 2a?

OWCP Form CA-2a, Notice of Recurrence, is used to report a recurrence of a previously accepted work-related injury or illness. A recurrence is defined as the documented need for additional medical treatment after release from treatment by your DOL doctor for the original injury or illness.

What is the difference between recurrence and aggravation?

A recurrence is when the symptoms of a previous injury recur spontaneously without any external cause. This would result in the old claim being reopened. An aggravation is when symptoms of a pre-existing injury are increased by a new and definable event.

What is a CA 1 or CA 2 form?

Most work-related medical conditions fall into two categories: (1) traumatic injury (Form CA-1, Federal Employees 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).

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What is a Ca2 form used for?

The CA-2 Notice of Occupational Disease form should be used if you have sustained an occupational disease injury on the job. An Occupational Disease is a condition produced in the work environment over a period longer than one work day or shift.

DOL-ESA Forms ca-2a 2026

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