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Federal Employee's Notice of Reset Traumatic Injury and Claim for Continuation of Pay/Compensation Print U.S. Department of Labor Office of Workers' Compensation Programs Employee: Please complete all boxes 1 - 15 below. Do not complete shaded areas. Witness: Complete bottom section 16. Employing Agency (Supervisor or Compensation Specialist): Complete shaded boxes a, b, and c. Employee Data 1. Name of employee...
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ca1
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