Federal Employees' Compensation Act Medical Reports and Compensation Claims

OMB 1240-0046

Address change for the Attending Physician's Report (CA-20), Authorization to Doctor for Audiologic and Otologic Evaluation OWCP Hearing (CA-1331), Claimant Request for Attending Physician (CA-1090) and Instructions (CA-1305). These forms are used for filing claims for wage loss or permanent impairment due to a Federal employment-related injury, and to obtain necessary medical documentation to determine whether a claimant is entitled to benefits under the Federal Employees Compensation Act (FECA), 5 U.S.C. 8101 et.seq.

The latest form for Federal Employees' Compensation Act Medical Reports and Compensation Claims expires 2021-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CA-7 FECA Medical Report Forms, Claim for Compensation Form and Instruction
Form CA-7 FECA Medical Report Forms, Claim for Compensation Form and Instruction
Justification for No material change to 1240-0046. Spanish translation of forms.docx Justification for No Material/Nonsubstantive Change
Justification for No material change to 1240-0046. Spanish translation of forms.docx Justification for No Material/Nonsubstantive Change
Occupational Employment and Wage Statistics.docx Supplementary Document
Occupational Employment and Wage Statistics.docx Supplementary Document
81 Fed. Reg 47418 (July 21, 2016).pdf Supplementary Document
81 Fed. Reg 47418 (July 21, 2016).pdf Supplementary Document
Supporting Statement for 1240-0046-- final.docx Supporting Statement A
Supporting Statement for 1240-0046-- final.docx Supporting Statement A
2023 GS Pay Chart.pdf Supplementary Document
2023 GS Pay Chart.pdf Supplementary Document
Federal Employees' Compensation Act _ U.S. Department of Labor.html Supplementary Document
Federal Employees' Compensation Act _ U.S. Department of Labor.html Supplementary Document
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction

All Historical Document Collections

202407-1240-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-08-20
202303-1240-001 Approved without change	Revision of a currently approved collection	2023-07-11
202206-1240-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2022-06-24
202101-1240-003 Approved without change	Extension without change of a currently approved collection	2021-02-24
202008-1240-067 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-10-22
202003-1240-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-04-12
202002-1240-018 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-02-25
201811-1240-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-11-14
201701-1240-002 Approved with change	Revision of a currently approved collection	2017-11-24
201602-1240-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-03-21
201406-1240-002 Approved without change	Revision of a currently approved collection	2014-10-31
201204-1240-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-04-30
201104-1240-001 Approved without change	Revision of a currently approved collection	2011-09-23
201003-1240-046 Approved without change	Extension without change of a currently approved collection	2010-03-12