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- Click ‘Get Form’ to open it in the editor.
- Begin with Part A, where the employee must fill in their name, date of birth, and Social Security Number. Ensure accuracy as this information is crucial for identification.
- Continue by providing details about the recurrence, including dates and circumstances. Use clear language to describe how the recurrence relates to the original injury.
- In Part B, if applicable, have the supervisor or compensation specialist complete their section. This includes confirming details about the employee's duty station and any medical care authorized.
- If you are no longer employed with the Federal Government, complete Part C by listing previous employers and job titles since leaving your last position.
- Review all entries for completeness and accuracy before submitting. Utilize our platform’s features to save your progress and make edits as needed.
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