Justification for Nonsubstantive change for the CA-722

Justification for Nonstantive change for the CA-722.docx

Notice of Law Enforcement Officer's Injury or Occupational Disease and Notice of Law Enforcement Officer's Death

Justification for Nonsubstantive change for the CA-722

OMB: 1240-0022

Document [docx]
Download: docx | pdf

Justification for Non-material/Non-substantive Change

Notice of Law Enforcement Officer’s Death (CA-722)


The Office of Workers' Compensation Programs (OWCP) administers the Federal Employees' Compensation Act (FECA), 5 U.S.C. 8101 et seq. The statute provides for the filing of claims for compensation for a non-Federal law enforcement officer, whose death is reported, was injured while in the performance of duty under the provisions of 5 U.S.C. 8101 et seq. The other forms in this clearance provide the basic information needed to process the claims for law enforcement officers made for injury or death.

Due to the reorganization of offices within the Office of Workers’ Compensation Programs Division of Federal Employees’, Longshore and Harbor Workers’ Compensation, the location of where the CA-722 form is received changed. With regards to the form itself, OWCP requests a change to reflect that all the completed forms be mailed to Jacksonville, Florida instead of London, Kentucky. The statement on page 6 of the form that reads All completed forms, documents, and inquiries should be sent to should now read All completed forms should be sent to. The address currently notes Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation, Federal Employees' Compensation Act, (OWCP/DFELHWC-FECA), PO Box 8311, London, KY 4072-8311. The address on page 6 should now be noted as Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation, Federal Employees' Compensation Act, (OWCP/DFELHWC-FECA), 400 W. Bay Street Suite 722, Jacksonville, FL 32202.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorHamai, Pamela A - OWCP
File Modified0000-00-00
File Created2024-10-26

© 2024 OMB.report | Privacy Policy