Get Department Of Labor Claim For Compensation Office Of Workers ' Compensation Programs Section 1 A

Filling out the Department of Labor Claim for Compensation form can be an essential step in obtaining the benefits you deserve. This guide provides you with clear and supportive instructions to complete SECTION 1 A of the form online, ensuring you understand each section and field.

Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the employee's name in the designated fields. Provide the first name, middle initial, and last name as required.
3. Input the OWCP file number, if available. This number is vital for tracking your claim.
4. Fill in the mailing address, including street, city, state, and ZIP code to ensure proper correspondence.
5. Provide the date of injury in the specified format (month, day, year). This date is crucial for determining eligibility.
6. Complete the optional email address field for notification purposes.
7. Input your Social Security number and telephone number, ensuring all information is accurate.
8. Indicate the type of compensation being claimed. Select from options including leave without pay, leave buy back, or other wage loss, as applicable.
9. If claiming specific types of wage loss, provide the type and any necessary details.
10. If applicable, indicate whether the claim includes a schedule award by proceeding to section 4 or completing section 3.
11. Report any earnings from outside employment during the periods claimed. Be truthful to avoid any penalties.
12. Complete the dependents' section, providing their names, Social Security numbers, and other details as required.
13. If applicable, answer questions regarding claims against third parties or previous disability benefits.
14. Review your entries for accuracy. Each component of this form is significant for your claim.
15. Once all sections are complete, save your changes, and download the form for submission. You may also print or share the form as necessary.

Take the next step and complete your Department of Labor forms online for a smoother claims process.