Justification for No material/Nonsubstantive Change (CA-1031, CA-5, CA-5b and (CA-1074) forms

Justification for No material/Nonsubstantive Change

Claim for Compensation by Surviving Spouse and/or Children (CA-5)

Claim for Compensation by Surviving Spouse and/or Children (CA-5b)

Letter to Dependents to Verify Claimant (CA-1031)

Letter to Parents in Death Claim Development (CA-1074)

The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is the agency responsible for administration of the Federal Employees’ Compensation Act (FECA), 5 U.S.C. 8101 et. seq., the Black Lung Benefits Act (BLBA), 30 U.S.C. 901 et. seq. and the Energy Employees’ Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 U.S.C. 7384 et. seq.  These statutes require OWCP to pay for appropriate medical and vocational rehabilitation services provided to beneficiaries. OWCP is requesting an address change to OWCP authorization forms ‘Claim for Compensation by Surviving Spouse and/or Children’ (CA-5), ‘Claim for Compensation by Surviving Spouse and/or Children’ (CA-5b), ‘Letter to Dependents to Verify Claimant’ (CA-1031), and ‘Letter to Parents in Death Claim Development’ (CA-1074) as the OWCP medical bill processor has procured a new mailroom and requires a means to receive those forms.

Approval of this request is needed by October 1, 2020 for posting of the form on the new medical bill processors web portal. This will allow ample time for the new mailroom contractor’s assumption of operations on October 1, 2020.  Any approval date beyond would necessitate a delay in operations until the request is approved.