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  1. Home
  2. Products
  3. Online PDF Forms
  4. USA
  5. Department of Labor
  6. Office of Workers' Compensation Programs

Agency: Office of Workers' Compensation Programs

Total forms: 84

Forms (84)

Form CA-1
  • English
  • Office of Workers' Compensation Programs

Form CA-1

Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
Form CA-1031
  • English
  • Office of Workers' Compensation Programs

Form CA-1031

Letter to Dependants to Verify Claimant Support
Form CA-1074
  • English
  • Office of Workers' Compensation Programs

Form CA-1074

Letter to Parents in Death Claim Development
Form CA-1108
  • English
  • Office of Workers' Compensation Programs

Form CA-1108

Statement of Recovery Letter with Long Form
Form CA-1122
  • English
  • Office of Workers' Compensation Programs

Form CA-1122

Statement of Recovery Letter with Short Form
Form CA-17
  • English
  • Office of Workers' Compensation Programs

Form CA-17

Duty Status Report
Form CA-2
  • English
  • Office of Workers' Compensation Programs

Form CA-2

Notice of Occupational Disease and Claim for Compensation
Form CA-2231
  • English
  • Office of Workers' Compensation Programs

Form CA-2231

Claim for Reimbursement Assisted Reemployment
Form CA-278
  • English
  • Office of Workers' Compensation Programs

Form CA-278

Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
Form CA-2a
  • English
  • Office of Workers' Compensation Programs

Form CA-2a

Notice of Occupational Disease and Claim for Compensation
Form CA-35
  • English
  • Office of Workers' Compensation Programs

Form CA-35

Evidence Required in Support of a Claim for Occupational Disease
Form CA-40
  • English
  • Office of Workers' Compensation Programs

Form CA-40

Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a
Form CA-41
  • English
  • Office of Workers' Compensation Programs

Form CA-41

Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity
Form CA-42
  • English
  • Office of Workers' Compensation Programs

Form CA-42

Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity
Form CA-5
  • English
  • Office of Workers' Compensation Programs

Form CA-5

Claim for Compensation by Widow, Widower, and/or Children
Form CA-5b
  • English
  • Office of Workers' Compensation Programs

Form CA-5b

Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren
Form CA-6
  • English
  • Office of Workers' Compensation Programs

Form CA-6

Official Supervisor's Report of Employee's Death
Form CA-7a
  • English
  • Office of Workers' Compensation Programs

Form CA-7a

Time Analysis Form, used for claiming compensation, including repurchase of paid leave
Form CA-7b
  • English
  • Office of Workers' Compensation Programs

Form CA-7b

Leave Buy Back (LBB) Worksheet/Certification and Election
Form CM-2907
  • English
  • Office of Workers' Compensation Programs

Form CM-2907

Report of Ventilatory Study
Form CM-623
  • English
  • Office of Workers' Compensation Programs

Form CM-623

Representative Payee Report
Form CM-623S
  • English
  • Office of Workers' Compensation Programs

Form CM-623S

Representative Payee Report
Form CM-787
  • English
  • Office of Workers' Compensation Programs

Form CM-787

Physician's/Medical Officer's Statement
Form CM-893
  • English
  • Office of Workers' Compensation Programs

Form CM-893

Certificate of Medical Necessity
Form CM-908
  • English
  • Office of Workers' Compensation Programs

Form CM-908

Notice of Termination, Suspension, Reduction or Increase in Benefit Payments
Form CM-910
  • English
  • Office of Workers' Compensation Programs

Form CM-910

Request To Be Selected As Payee
Form CM-911
  • English
  • Office of Workers' Compensation Programs

Form CM-911

Miner's Claim For Benefits Under The Black Lung Benefits Act
Form CM-911a
  • English
  • Office of Workers' Compensation Programs

Form CM-911a

Employment History
Form CM-912
  • English
  • Office of Workers' Compensation Programs

Form CM-912

Survivor's Form For Benefits Under The Black Lung Benefits Act
Form CM-913
  • English
  • Office of Workers' Compensation Programs

Form CM-913

Description Of Coal Mine Work and Other Employment
Form CM-929
  • English
  • Office of Workers' Compensation Programs

Form CM-929

Report of Changes That May Affect Your Black Lung Benefits
Form CM-929P
  • English
  • Office of Workers' Compensation Programs

Form CM-929P

Report of Changes That May Affect Your Black Lung Benefits
Form CM-933
  • English
  • Office of Workers' Compensation Programs

Form CM-933

Roentgenographic Interpretation
Form CM-933b
  • English
  • Office of Workers' Compensation Programs

Form CM-933b

Roentgenographic Quality Rereading
Form CM-936
  • English
  • Office of Workers' Compensation Programs

Form CM-936

Authorization For Release Of Medical Information (Black Lung Benefits)
Form CM-972
  • English
  • Office of Workers' Compensation Programs

Form CM-972

Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor
Form CM-981
  • English
  • Office of Workers' Compensation Programs

Form CM-981

Certification by School Official
Form CM-988
  • English
  • Office of Workers' Compensation Programs

Form CM-988

Medical History and Examination for Coal Mine Workers' Pneumoconiosis
Form EE-1
  • English
  • Office of Workers' Compensation Programs

Form EE-1

Employee's Claim
Form EE-2
  • English
  • Office of Workers' Compensation Programs

Form EE-2

Survivor's Claim
Form EE-3
  • English
  • Office of Workers' Compensation Programs

Form EE-3

Employment History
Form EE-4
  • English
  • Office of Workers' Compensation Programs

Form EE-4

Employment History Affidavit
Form EE-7
  • English
  • Office of Workers' Compensation Programs

Form EE-7

Medical Requirements
Form LS-1
  • English
  • Office of Workers' Compensation Programs

Form LS-1

Request for Examination and/or Treatment
Form LS-18
  • English
  • Office of Workers' Compensation Programs

Form LS-18

Pre-Hearing Statement
Form LS-200
  • English
  • Office of Workers' Compensation Programs

Form LS-200

Report of Earnings
Form LS-201
  • English
  • Office of Workers' Compensation Programs

Form LS-201

Notice of Employee's Injury or Death
Form LS-202
  • English
  • Office of Workers' Compensation Programs

Form LS-202

Employer's First Report of Injury or Occupational Illness
Form LS-203
  • English
  • Office of Workers' Compensation Programs

Form LS-203

Employee's Claim for Compensation
Form LS-204
  • English
  • Office of Workers' Compensation Programs

Form LS-204

Attending Physician's Supplementary Report
Form LS-206
  • English
  • Office of Workers' Compensation Programs

Form LS-206

Payment of Compensation Without Award
Form LS-207
  • English
  • Office of Workers' Compensation Programs

Form LS-207

Notice of Controversion of Right to Compensation
Form LS-208
  • English
  • Office of Workers' Compensation Programs

Form LS-208

Notice of Final Payment or Suspension of Compensation Payments
Form LS-210
  • English
  • Office of Workers' Compensation Programs

Form LS-210

Employer's Supplementary Report of Accident or Occupational Illness
Form LS-262
  • English
  • Office of Workers' Compensation Programs

Form LS-262

Claim for Death Benefits
Form LS-265
  • English
  • Office of Workers' Compensation Programs

Form LS-265

Certification of Funeral Expenses
Form LS-266
  • English
  • Office of Workers' Compensation Programs

Form LS-266

Application for Continuation of Death Benefit for Student
Form LS-267
  • English
  • Office of Workers' Compensation Programs

Form LS-267

Claimant's Statement
Form LS-271
  • English
  • Office of Workers' Compensation Programs

Form LS-271

Application for Self-Insurance
Form LS-272
  • English
  • Office of Workers' Compensation Programs

Form LS-272

Application to write Longshore Insurance (Carriers)
Form LS-274
  • English
  • Office of Workers' Compensation Programs

Form LS-274

Report of Injury Experience of Insurance Carrier or Self-Insured Employer
Form LS-275ic
  • English
  • Office of Workers' Compensation Programs

Form LS-275ic

Agreement and Undertaking (Insurance Carrier)
Form LS-275si
  • English
  • Office of Workers' Compensation Programs

Form LS-275si

Agreement and Undertaking (Self-Insured Employer)
Form LS-276
  • English
  • Office of Workers' Compensation Programs

Form LS-276

Application for Security Deposit Determination. State Guarantee Fund Longshore Security Factor Chart
Form LS-33
  • English
  • Office of Workers' Compensation Programs

Form LS-33

Approval of Compromise of Third Person Cause of Action
Form LS-4
  • English
  • Office of Workers' Compensation Programs

Form LS-4

Attorney Fee Approval Request
Form LS-426
  • English
  • Office of Workers' Compensation Programs

Form LS-426

Request for Earnings Information
Form LS-5
  • English
  • Office of Workers' Compensation Programs

Form LS-5

Application for Special Fund Relief
Form LS-513
  • English
  • Office of Workers' Compensation Programs

Form LS-513

Report of Payments
Form LS-570
  • English
  • Office of Workers' Compensation Programs

Form LS-570

Carrier's Report of Issuance of Policy (formerly Card Report of Insurance)
Form LS-6
  • English
  • Office of Workers' Compensation Programs

Form LS-6

Commutation Application
Form LS-7
  • English
  • Office of Workers' Compensation Programs

Form LS-7

Request for Intervention
Form LS-8
  • English
  • Office of Workers' Compensation Programs

Form LS-8

Settlement Approval Request Section 8(i)
Form LS-801
  • English
  • Office of Workers' Compensation Programs

Form LS-801

Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers
Form LS-802
  • English
  • Office of Workers' Compensation Programs

Form LS-802

Waiver of Service by Registered or Certified Mail for Claimants and Authorized Representatives
Form LS-9
  • English
  • Office of Workers' Compensation Programs

Form LS-9

Stipulation Approval Request
Form OWCP-04
  • English
  • Office of Workers' Compensation Programs

Form OWCP-04

Uniform Billing Form
Form OWCP-1168
  • English
  • Office of Workers' Compensation Programs

Form OWCP-1168

Provider Enrollment form
Form OWCP-1500
  • English
  • Office of Workers' Compensation Programs

Form OWCP-1500

Health Insurance Claim Form
Form OWCP-16
  • English
  • Office of Workers' Compensation Programs

Form OWCP-16

Rehabilitation Plan And Award
Form OWCP-17
  • English
  • Office of Workers' Compensation Programs

Form OWCP-17

Rehabilitation Maintenance Certificate
Form OWCP-20
  • English
  • Office of Workers' Compensation Programs

Form OWCP-20

Overpayment Recovery Questionnaire
Form OWCP-44
  • English
  • Office of Workers' Compensation Programs

Form OWCP-44

Rehabilitation Action Report
Settlement Judge Request
  • English
  • Office of Workers' Compensation Programs

Settlement Judge Request

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