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 revised FECA Medical Report Forms, Claim for Compensation Form and Instruction
Justification for Nonmaterial Change - CA-7 Schedule Award_20250219.docx Justification for No Material/Nonsubstantive Change
ECOMP CA-7 Sample (12-3-24).docx Supplementary Document
Occupational Employment and Wage Statistics.docx Supplementary Document
81 Fed. Reg 47418 (July 21, 2016).pdf Supplementary Document
Supporting Statement for 1240-0046-- final.docx Supporting Statement A
2023 GS Pay Chart.pdf Supplementary Document
Federal Employees' Compensation Act _ U.S. Department of Labor.html Supplementary Document
FECA Medical Report Forms, Claim for Compensation Form and Instruction

All Historical Document Collections

202502-1240-001	No material or nonsubstantive change to a currently approved collection	2025-02-19
202412-1240-001	No material or nonsubstantive change to a currently approved collection	2024-12-05
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