CA-2231 – Employer Claim for Reimbursement (Assisted Reemployment) Fillable PDF

The CA-2231 is the official Employer Claim for Reimbursement – Assisted Reemployment (AR) Program form used by the U.S. Department of Labor. Employers who have incurred costs related to reemployment services can request reimbursement by completing this form.

What Is the CA-2231 Form?

Form CA-2231 collects detailed information about the employer, the employee(s) involved, the nature of the reemployment services provided, and the associated expenses. The form is required under the Occupational Safety and Health Administration (OSHA) Workers’ Compensation Programs (OWCP) guidelines.

How to Complete the CA-2231 Online

Instead of downloading, printing, and editing a static PDF, you can fill out the form directly in your browser using Formize’s secure PDF Filler app. Follow the simple steps below.

Common Mistakes to Avoid

• Leaving required fields blank – the filler will highlight missing data.
• Entering totals that don’t match line‑item amounts – double‑check calculations.
• Using an outdated version of the form – this page always provides the latest CA-2231 (June 2004).

Where to Submit the Completed Form

After you finish, download the completed PDF and mail it to the address listed on the last page of the form, or submit electronically if your agency permits electronic filing.

FAQ – Quick Answers

For quick help, scroll down to the FAQ section or use the “Fill out this form” button to launch the Formize filler.