Get Ca7 Form

Filling out the Ca7 Form online is a crucial step for employees seeking compensation for work-related injuries. This guide provides clear instructions on how to successfully complete the form to ensure your claim is processed efficiently.

Follow the steps to complete the Ca7 Form online.

1. Click ‘Get Form’ button to access the Ca7 Form and open it in your browser.
2. In Section 1, enter your name as the employee, including your first, middle, and last names. Provide your mailing address, email (optional), and date of injury. Ensure all information is accurate.
3. In Section 2, input your Social Security number and contact information. Specify the type of compensation you are claiming and the inclusive date range for your claim. Indicate if the compensation is for leave without pay, leave buy back, or other wage loss.
4. Section 3 requires you to report all earnings from any outside employment during the claimed period. Indicate whether you have worked outside of your federal job and provide details if applicable.
5. In Section 4, confirm if this is your first CA-7 claim for compensation. If changes have occurred regarding your dependents or direct deposit, address this in the subsequent sections.
6. Complete Sections 5 through 7 with details about your dependents, including names, Social Security numbers, and support payment information. Ensure to check all relevant questions.
7. In Section 6, provide any information regarding claims against a third party or other benefits received, including details of the claims made.
8. Section 7 requires you to sign and date the form, attesting to the accuracy of the information provided.
9. For the employing agency portion, if you are the supervisor, complete sections 8 through 15 as directed after the employee submits their part. Then, forward the form to the appropriate office.
10. Review your completed form for accuracy. Once finalized, save changes, download, print, or share the form as needed.

Complete your Ca7 Form online today to ensure your compensation claim is submitted accurately and efficiently.