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Reset Claim for Compensation SECTION 1 a. Name of Employee Print U.S. Department of Labor Office of Workers' Compensation Programs EMPLOYEE PORTION First Last OMB No. 1240-0046 Expires: 10-31-2014
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The Form CA-1 was developed to ensure regulatory compliance and to be more customer friendly. The form must be completed by the injured employee, a witness, and the injured employee's supervisor.
The Office of Workers' Compensation Programs (OWCP) administers programs that provide wage-replacement benefits, medical treatment, vocational rehabilitation, and other benefits to federal workers (or eligible dependents)who are injured at work or acquire an occupational disease.
Federal Employees' Compensation Program. U.S. Department of Labor.
Form CA-1 must be complete in a detailed manner; that is, you are expected to describe how you sustained your injuries, what you were doing and so on, or how you fell sick. You are also required to input the date, or, if you gradually became sick, indicate the time period.
OWCP | U.S. Department of Labor.
The CA-1 form is used if the employee has sustained a Traumatic Injury on the job. Traumatic Injury - A wound or other condition of the body caused by external force, including stress or strain.

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Department of Labor claim is a formal request for assistance or resolution of a workplace dispute filed with the Department of Labor.
Employees who believe their rights have been violated or that they have not been fairly compensated are required to file a Department of Labor claim.
To fill out a Department of Labor claim, individuals should contact the Department of Labor for specific instructions and forms.
The purpose of a Department of Labor claim is to ensure that employees are treated fairly and in accordance with labor laws.
Information such as details of the dispute, dates and times of events, and any relevant documentation must be reported on a Department of Labor claim.
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