Notice of Recurrence

OMB 1240-0009

OMB 1240-0009

This form is used by current, or occasionally former, Federal employees to claim wage loss or medical treatment resulting from a recurrence of a work-related injury while Federally employed. The information is necessary to ensure the accurate payment of benefits.

The latest form for Notice of Recurrence expires 2021-01-31 and can be found here.


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