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Reset Print Claim for Compensation U.S. Department of Labor Employment Standards Administration Office of Workers' Compensation Programs EMPLOYEE PORTION SECTION 1 a. Name of Employee Last First Middle.

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Leave Buy Back. Compensation for Leave without Pay. The CA-7 must be filed electronically through the Employees' Compensation Operations & Management Portal (ECOMP). If you do not already have an account, one must be created at http://.ecomp.dol.gov.

You can elect to go on Leave Without Pay and submit Form CA-7 - Claim for Compensation to request wage loss payments from the DOL. Form CA-7 alerts the DOL that you are not receiving any income and initiates wage loss pay.

Leave Buy Back. Compensation for Leave without Pay. The CA-7 must be filed electronically through the Employees' Compensation Operations & Management Portal (ECOMP). If you do not already have an account, one must be created at http://.ecomp.dol.gov.

This form is intended to accompany Form CA-7, Claim for Compensation, when the employee is claiming leave buy back. Things to Know About Leave Buy Back: When an employee uses their sick or annual leave to cover an injury-related absence from work, they may elect to receive compensation instead.

Form CA-17 is designed to be filled out by the injured worker's supervisor and his/her treating physician to complete. It is split into two sections: A and B. Side A is to be completed by the employee's supervisor.

Form CA-7 is used by federal workers seeking to claim compensation for traumatic injuries suffered while on the job, as well as those who may have sustained an occupational disease during the performance of work-related duties. This form may be filled online, or downloaded and filled offline.

In case you're receiving continuation of pay, you must ask that form CA-7 be availed to you within 30 days of the COP period, and then sent over to OWCP by the 40th day of COP. Your employer will then have 5 days to submit the form to OWCP after checking it for accuracy and completion.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232