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Click ‘Get Form’ to open the CA-7 form in the editor.
Begin with Section 1, filling in your name, mailing address, date of injury, and Social Security number. Ensure all details are accurate for proper processing.
In Section 2, specify the inclusive date range for your claim. Indicate if the leave was intermittent and select any applicable wage loss types.
Proceed to Section 3 to report any outside employment during the claimed period. This is crucial for compliance and accuracy.
Complete Sections 5 through 7 regarding dependents and any changes in your situation since your last claim. Be thorough to avoid delays.
Review all sections for completeness before submitting. Use our platform’s tools to ensure clarity and correctness.
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20 CFR 10.102 - How and when is a claim for wage loss
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