Form ca 7b 2026

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The document is a Leave Buy Back (LBB) Worksheet from the U.S. Department of Labor's Office of Workers' Compensation Programs, designed for employees to claim compensation for leave used due to job-related injuries. It outlines the process for employees to elect to repurchase their leave by providing necessary information such as pay rates, hours claimed, and agency certification. The document also includes instructions for both employees and agencies regarding the calculation of compensation entitlement and the implications of changing leave status.

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Click ‘Get Form’ to open the CA 7b in the editor.
Begin by entering your name, Social Security Number, and OWCP File Number at the top of the form. Ensure accuracy as this information is crucial for processing.
In Section I, provide details about your compensation claim. Enter your weekly base pay rate and any additions such as night differentials or Sunday premiums. Calculate your total weekly payrate by adding these amounts.
Circle the appropriate compensation rate (2/3 or 3/4) based on your dependents. This will affect your total entitlement calculation.
Complete Section II by having an agency official certify the information provided. They will need to sign and date this section.
Finally, in Section III, indicate whether you elect to repurchase leave or not by checking the appropriate box and signing the form.

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