Justification for Non-substantive change

Justification for No Material/Non-substantive Change

Long Form Statement of Recovery and Short Form Statement of Recovery (CA-1108 and CA-1122)

OMB Control No. 1240-0001 (February 28, 2025)

The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) administers the Federal Employees’ Compensation Act (FECA), 5 U.S.C. § 8101 et seq. The statute provides compensation to federal employees or their survivors (collectively known as FECA beneficiaries) for employment-related injuries or deaths, regardless of fault. FECA defines compensation as the “money allowance payable to [a FECA beneficiary] and any other benefits paid for from the Employees’ Compensation Fund,” 5 U.S.C. § 8101(12). Continuation of pay (COP) is explicitly excluded from the definition of compensation, 5 U.S.C. § 8118(e).

The James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (NDAA) was enacted on December 23, 2022. Section 5305 of the NDAA, Fairness for Federal Firefighters, expanded the subrogation provisions of FECA Sections 8131 and 8132 to authorize reimbursement to the United States for a FECA beneficiary’s recovery for COP from any third party. Specifically, a FECA beneficiary who is eligible for COP or compensation is required to prosecute or assign to the United States any claim against a third party responsible for the FECA-covered injury. 5 U.S.C. § 8131. When there is a recovery from a third party under Sections 8131 or 8132, the United States has a statutory right to reimbursement that includes the amount of money to be paid to the United States and the surplus. Thus, when a FECA beneficiary prosecutes a matter and recovers from a third party responsible for the FECA-covered injury, the FECA beneficiary will pay to the United States the amount of COP and compensation they received related to the injury (subject to deductions for the statutory minimum share, the costs of a suit, and a reasonable attorney’s fee), commonly referred to as the refund, and any surplus will be applied to both future compensation and future COP for that same injury. 5 U.S.C. § 8132. Likewise, when there is a recovery from a third party in a claim assigned to the United States, the United States will retain the amount of COP and compensation paid to the FECA beneficiary related to the injury (subject to deductions for the statutory minimum share), but the surplus will be credited against only future compensation. 5 U.S.C. § 8131.

OWCP Division of Federal Employees’, Longshore and Harbor Workers’ Compensation (DFELHWC) instituted a policy when it issued FECA Bulletin 24-01 on March 15, 2024, to provide guidance on implementing the NDAA Amendments to the FECA third party subrogation provisions.

Per FECA Bulletin 24-01, in accordance with amended Sections 8131 and 8132 of the FECA, the employing agency will provide to the Office of the Solicitor (SOL) the COP amount paid to each claimant. SOL will share the COP information with the FECA beneficiary in response to requests for refundable disbursements.

The form CA-1108, Long Form Statement of Recovery, and the form CA-1122, Short Form Statement of Recovery, are used to determine the reimbursement due to the United States. Now, because of the NDAA amendments, COP paid to the beneficiary is considered a reimbursable amount paid to the United States.

OWCP requests it be allowed to make non-substantive changes to the CA-1108 and CA-1122 forms to be consistent with the change in law and update the agency’s mailing address. These changes do not affect the burden hours. The burden hours remain the same. We request the following changes:

Form CA-1108:

On the form CA-1108, Long Form Statement of Recovery, Line 15 was changed from Refundable Disbursements to Total Disbursements (Refundable Disbursements and Continuation of Pay). Line 16 was also changed from Subtotal G (lower line 14 or Refundable Disbursements) to Subtotal G (lower Line 14 or Total Disbursements).

In the Instructions for Form CA-1108, Line 15, Line 16, and Line 19 were updated as follows:

1) Line 15 was changed from REFUNDABLE DISBURSEMENTS to TOTAL DISBURSEMENTS. The Instructions for Line 15 were updated from Enter all amounts paid by OWCP for compensation and medical benefits but not Continuation of Pay), less any amounts of refundable disbursements listed on any prior Forms EN-1108 or CA-1108, in the space provided to Enter the total of the Refundable Disbursements (all amounts paid by OWCP for compensation and medical benefits) and the Continuation of Pay paid by the employing agency, less any amounts listed on Line 16 (Subtotal G) of any prior Forms EN-1108 or CA-1108, in the space provided;

2) Line 16 SUBTOTAL G was changed from – Compare Subtotal F (line 14) with the refundable disbursements (Line 15), and enter the lower of the two on line 16 to Compare Subtotal F (Line 14) with the Total Disbursements (Line 15), and enter the lower of the two on Line 16; and

3) Line 19 CREDIT AGAINST FUTURE BENEFITS (SURPLUS) was changed from If Subtotal F (Line 14) is less than the Refundable Disbursements (Line 15), there is no credit to be applied against future benefits. If Subtotal F (Line 14) is greater than the refundable disbursements (Line 15) a credit against future benefits must be applied and is determined by subtracting the refundable disbursements (Line 15) from Subtotal F (Line 14) to If Subtotal F (Line 14) is less than the Total Disbursements (Line 15), there is no credit to be applied against future benefits. If Subtotal F (Line 14) is greater than the Total Disbursements (Line 15), a credit against future benefits must be applied and is determined by subtracting the Total Disbursements (Line 15) from Subtotal F (Line 14).

Form CA-1122:

Additionally, on the form CA-1122, Short Form Statement of Recovery, Line 8 was changed from Enter Refundable Disbursements to Enter Total Disbursements (Refundable Disbursements and Continuation of Pay (COP)). The corresponding changes were made to the Instructions for Form CA-1122 Line 8. The Instructions were changed from Line 8 – OWCP DISBURSEMENTS – All amounts paid by OWCP (compensation and medical benefits, but not continuation of pay (COP)) less the gross amount of any prior refunds made (from Line 7 on any earlier EN-1122 or CA-1122 are to be entered in the space provided to Line 8 – TOTAL DISBURSEMENTS – The total of all amounts paid by OWCP (compensation and medical benefits) and the Continuation of Pay (COP) paid by the employing agency, less the gross amount of any prior refunds made (from Line 9 on any prior EN-1122 or CA-1122), are to be entered in the space provided.

The Instructions for Line 9 – REFUND TO OWCP of the form CA-1122 was changed from Compare Line 7 with Line 8 (refundable disbursements) and enter the lower of the two on Line 9 to Compare Line 7 with Line 8 (total disbursements) and enter the lower of the two on Line 9. The last sentence in the Instructions for Line 9 was changed from NOTE: You must contact OWCP to obtain a current history of the disbursements made to you and your medical providers for compensation and medical benefits to NOTE: You must contact OWCP to obtain a current history of the disbursements made to you and your medical providers for compensation and benefits and COP.

Lastly, OWCP requests that the refund address on both the forms CA-1108 and CA-1122 be revised. The address currently notes the U.S. Department of Labor, Office of the Solicitor, Division of Federal Employees’ and Energy Workers’ Compensation, 200 Constitution Avenue NW, Room S4325, Washington, DC 20210. The room number on where to send the refund payment was changed. The address should now be noted as U.S. Department of Labor, Office of the Solicitor, Division of Federal Employees’ and Energy Workers’ Compensation, 200 Constitution Avenue, N.W., Room N-2625, Washington, D.C. 20210.

The revised forms are attached to this change request.