Get Dol Ca-1 2018-2025

The DoL CA-1 form is essential for federal employees reporting a traumatic injury and claiming benefits under the Federal Employees' Compensation Act (FECA). This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently online.

Follow the steps to complete your DoL CA-1 form with ease

1. Click 'Get Form' button to access the DoL CA-1 form and open it in your preferred online document editor.
2. Begin by filling in box 1 with the employee's full name in the order of last, first, and middle. Ensure this information matches official records for accuracy.
3. Enter the date of birth in box 3 using the format Mo. Day Yr. This information is crucial for processing the claim.
4. Provide the employee's email address in box 1a. This supports communication regarding the claim, though direct case-related emails are generally restricted.
5. Specify the employee's sex in box 4 by selecting 'Male' or 'Female'.
6. Fill out box 5 with the home telephone number of the employee. This is necessary for any follow-up communications.
7. Input the employee's Social Security number in box 2. This is mandatory for identification and verification.
8. Record the employee's home mailing address in box 7, including the street address, city, state, and ZIP code.
9. Indicate the number of dependents in box 8, detailing spouses and children under 18 years where applicable.
10. Describe the place of injury in box 9, providing specific details about the location.
11. Enter the date the injury occurred in box 10, following the format Mo. Day Yr.
12. Complete box 11 with the date this notice is being filed, ensuring it is the current date.
13. Document the time of the injury in box 12, noting the appropriate AM or PM designation.
14. In box 13, explain the cause of the injury in detail, including context and any contributing factors.
15. Specify the nature of the injury in box 14, identifying both the injury and the affected body part.
16. Review box 15, which is a declaration. Sign and date to confirm the accuracy of the information provided.
17. If applicable, have the witness complete the bottom section 16 with their statement regarding the injury.
18. For the supervisor section, ensure that shaded boxes (a, b, c) are completed with the appropriate codes by the supervisor or compensation specialist.
19. Once all information is filled out accurately, you can save your changes, download the completed form, print it, or share it as needed.

Complete your DoL CA-1 form online today for swift processing of your claim.