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U.S. Department of Labor - Office of Workers' Compensation Programs Forms

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Form EE-2 Survivor's Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act PDF

Form EE-2 Survivor's Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form EE-3 Employment History for a Claim Under the Energy Employees Occupational Illness Compensation Program Act PDF

Form EE-3 Employment History for a Claim Under the Energy Employees Occupational Illness Compensation Program Act
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form EE-1 Worker's Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act PDF

Form EE-1 Worker's Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act PDF

Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form CA-1 Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation PDF

Form CA-1 Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
United States Federal Legal Forms United States Legal Forms
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Form CA-2 Notice of Occupational Disease and Claim for Compensation PDF

Form CA-2 Notice of Occupational Disease and Claim for Compensation
United States Federal Legal Forms United States Legal Forms
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Form CA-5 Claim for Compensation by Surviving Spouse and/or Children PDF

Form CA-5 Claim for Compensation by Surviving Spouse and/or Children
United States Federal Legal Forms United States Legal Forms
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Form CA-7 Claim for Compensation PDF

Form CA-7 Claim for Compensation
United States Federal Legal Forms United States Legal Forms
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Form LS-8 Settlement Approval Request 8(I) PDF

Form LS-8 Settlement Approval Request 8(I)
United States Federal Legal Forms United States Legal Forms
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Form LS-8 Settlement Approval Request Section 8(I) PDF

Form LS-8 Settlement Approval Request Section 8(I)
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form LS-7 Request for Intervention PDF

Form LS-7 Request for Intervention
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form LS-5 Application for Special Fund Relief PDF

Form LS-5 Application for Special Fund Relief
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form LS-9 Stipulation Approval Request PDF

Form LS-9 Stipulation Approval Request
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form LS-4 Attorney Fee Approval Request PDF

Form LS-4 Attorney Fee Approval Request
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form LS-6 Commutation Application PDF

Form LS-6 Commutation Application
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form OWCP-16 Rehabilitation Plan and Award PDF

Form OWCP-16 Rehabilitation Plan and Award
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form LS-18 Pre-hearing Statement PDF

Form LS-18 Pre-hearing Statement
United States Federal Legal Forms United States Legal Forms
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Form OWCP-20 Overpayment Recovery Questionnaire PDF

Form OWCP-20 Overpayment Recovery Questionnaire
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form OWCP-17 Rehabilitation Maintenance Certificate PDF

Form OWCP-17 Rehabilitation Maintenance Certificate
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form CA-2A Notice of Recurrence PDF

Form CA-2A Notice of Recurrence
United States Federal Legal Forms Legal United States Legal Forms
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Form CA-12 Claim for Continuance of Compensation Under the Federal Employees' Compensation Act PDF

Form CA-12 Claim for Continuance of Compensation Under the Federal Employees' Compensation Act
United States Federal Legal Forms United States Legal Forms
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Form CA-42 Official Notice of Employees' Death for Purposes of Feca Section 8102a Death Gratuity PDF

Form CA-42 Official Notice of Employees' Death for Purposes of Feca Section 8102a Death Gratuity
United States Federal Legal Forms United States Legal Forms
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Form CA-41 Claim for Survivor Benefits Under the Federal Employees' Compensation Act Section 8102a Death Gratuity PDF

Form CA-41 Claim for Survivor Benefits Under the Federal Employees' Compensation Act Section 8102a Death Gratuity
United States Federal Legal Forms United States Legal Forms
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Form CA-40 Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment Under 5 U.s.c. 8102a PDF

Form CA-40 Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment Under 5 U.s.c. 8102a
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form CA-20 Attending Physician's Report PDF

Form CA-20 Attending Physician's Report
United States Federal Legal Forms United States Legal Forms
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Form OWCP-5B Work Capacity Evaluation Cardiovascular/Pulmonary Conditions PDF

Form OWCP-5B Work Capacity Evaluation Cardiovascular/Pulmonary Conditions
United States Federal Legal Forms United States Legal Forms
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Form OWCP-5A Work Capacity Evaluation - Psychiatric/Psychological Conditions PDF

Form OWCP-5A Work Capacity Evaluation - Psychiatric/Psychological Conditions
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form OWCP-5C Work Capacity Evaluation - Musculoskeletal Conditions PDF

Form OWCP-5C Work Capacity Evaluation - Musculoskeletal Conditions
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form CA-17 Duty Status Report PDF

Form CA-17 Duty Status Report
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form OWCP-44 Rehabilitation Action Report PDF

Form OWCP-44 Rehabilitation Action Report
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form CA-5B Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren PDF

Form CA-5B Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
United States Federal Legal Forms United States Legal Forms
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Form OWCP-04 Uniform Billing Form PDF

Form OWCP-04 Uniform Billing Form
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form OWCP-957 Medical Travel Refund Request PDF

Form OWCP-957 Medical Travel Refund Request
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form CM-911 Miner's Claim for Benefits Under the Black Lung Benefits Act PDF

Form CM-911 Miner's Claim for Benefits Under the Black Lung Benefits Act
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form CM-910 Request to Be Selected as Payee PDF

Form CM-910 Request to Be Selected as Payee
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form LS-207 Notice of Controversion of Right to Compensation PDF

Form LS-207 Notice of Controversion of Right to Compensation
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form LS-208 Notice of Payments PDF

Form LS-208 Notice of Payments
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form CM-787 Physician's/Medical Officer's Statement PDF

Form CM-787 Physician's/Medical Officer's Statement
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form CM-929 Report of Changes That May Affect Your Black Lung Benefits PDF

Form CM-929 Report of Changes That May Affect Your Black Lung Benefits
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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Form LS-265 Certification of Funeral Expenses PDF

Form LS-265 Certification of Funeral Expenses
U.S. Department of Labor United States Federal Legal Forms Legal United States Legal Forms
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