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  • Dol Ca-2a 2024

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This form. OMB No. 1240-0009 Employing Agency (Supervisor or Compensation Specialist): Complete Part B. Expires: 01/31/2027 Note: Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Part A - Employee 2. Social Security Number 3. OWCP file number for original injury 1. Name of employee (Last, First, Middle Initial) 4. Date of Birth Mo./Day/Yr. 6. Home telephone 5. Sex Male Female 7. Home mailing address (include stre.

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How to fill out the DoL CA-2a online

The DoL CA-2a form, also known as the Notice of Recurrence, is crucial for employees seeking to document a recurrence of a work-related condition. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently online, ensuring that you meet all necessary requirements.

Follow the steps to complete the DoL CA-2a online efficiently.

  1. Click the ‘Get Form’ button to access the DoL CA-2a, opening it in your preferred editor.
  2. Begin with Part A, where the employee provides their name, Social Security number, OWCP file number, and other personal information. Ensure that all details are accurate.
  3. Proceed to fill in the Date of Birth, home telephone number, and sex. It's important to provide correct contact details.
  4. In the mailing address section, include the full street address, city, state, and ZIP code as per the instructions for address requirements.
  5. Indicate your dependents, if applicable, confirming if you have a spouse or any children under 18 years.
  6. Input the name and address of the employing agency at the time of the original injury, along with the original injury’s date and hour.
  7. Record the date and hour of the recurrence and any subsequent work stoppage periods.
  8. Detail any claims for medical treatment, including if you are also requesting compensation for continuation of pay.
  9. Provide comprehensive descriptions of your limitations, ongoing condition, and medical treatment received since the original injury.
  10. Carefully review all responses for accuracy and completeness before signing and dating the form.

Ensure you complete and submit your DoL CA-2a online to facilitate a smooth claims process.

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Most work-related medical conditions fall into two categories: (1) traumatic injury (Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation), and (2) occupational disease (Form CA-2, Notice of Occupational Disease and Claim for Compensation).

CA-7a* Time Analysis Form, used for claiming compensation, including repurchase of paid leave.

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.

A CA-2a form is a claim for recurrence. If for instance an employee has an injured back and they go out of work for awhile and they're returned back to work, and then they have a worsening of that back injury condition, they would claim a recurrence. To do that they would file a form CA-2a.

CA-2 - Notice of Occupational Disease and Claim for Compensation. Use for occupational disease or illness claims - medical condition developed over more than one workday (i.e. carpal tunnel, skin disease). CA-2a - Federal Employee's Notice of Recurrence of Disability and Claim for Pay/Compensation.

This form is used by an employee to claim compensation in an established case for traumatic injury or occupational disease.

Fillable Forms Form NumberOWCP's Form Title / DescriptionCA-5*Claim for Compensation by Surviving Spouse and/or ChildrenCA-5b*Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildrenCA-6Official Supervisor's Report of Employee's DeathCA-7*Claim for Compensation37 more rows

CA-5. Subject. Claim for Compensation by Widow, Widower, and/or Children.

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