Form CA-7a "Time Analysis Form"

What Is Form CA-7a?

Form CA-7a, Time Analysis Form, is a document issued by the U.S. Department of Labor (DOL) for federal workers. The application is used when claiming FECA compensation (The Federal Employees' Compensation Act), including the repurchase of paid leave.

This form is supposed to be used when a federal worker claims reimbursement for more than one consecutive period of leave. The application can be submitted by federal workers during their compensation cases.

DOL Form CA-7a was issued in June 1996 and hasn't been revised since.

A CA-7a Form fillable version is available for download below.

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Download Form CA-7a "Time Analysis Form"

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Time Analysis Form
U.S. Department of Labor
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Office of Workers' Compensation Programs
Employee Statement - Please carefully read instructions on reverse before filling out this form.
(Last, First, Middle)
1. Name of Employee:
3. OWCP File Number
2. SSN
5. Total Hours Claimed
4. Period Covered by This Form:
for LWOP:
To:
From:
for Leave BuyBack
6. In ''Type of Leave Used'' column, use codes "S" = Sick, "A" = Annual, "O" = Other. If Compensation is claimed for
date, indicate "Yes'' in ''Compensation Claimed'' column.
Type of
Number of Hours
Compensation
Reason for Leave Use/Remarks
Leave
Claimed?
(e.g., doctor visit, therapy, etc.)
Date(s)
Leave
Hol
Used
LWOP Worked
Totals
Signature of Claimant
Date Signed
7. Agency Statement/Certification: I certify the above is accurate, except as follows:
Signature of Agency Official
Date Signed
Form CA 7a
June 1996
Time Analysis Form
U.S. Department of Labor
Reset
Print
Office of Workers' Compensation Programs
Employee Statement - Please carefully read instructions on reverse before filling out this form.
(Last, First, Middle)
1. Name of Employee:
3. OWCP File Number
2. SSN
5. Total Hours Claimed
4. Period Covered by This Form:
for LWOP:
To:
From:
for Leave BuyBack
6. In ''Type of Leave Used'' column, use codes "S" = Sick, "A" = Annual, "O" = Other. If Compensation is claimed for
date, indicate "Yes'' in ''Compensation Claimed'' column.
Type of
Number of Hours
Compensation
Reason for Leave Use/Remarks
Leave
Claimed?
(e.g., doctor visit, therapy, etc.)
Date(s)
Leave
Hol
Used
LWOP Worked
Totals
Signature of Claimant
Date Signed
7. Agency Statement/Certification: I certify the above is accurate, except as follows:
Signature of Agency Official
Date Signed
Form CA 7a
June 1996
Instructions for Completing Form CA-7A
Time Analysis
General: This form is used when claiming FECA compensation, including repurchase of paid leave.
It must be used when claiming compensation for more than one consecutive period of leave.
Instructions for Employee:
Blocks 1, 2, and 3: Self-explanatory.
Block 4: Indicate beginning and ending dates covered by this form. These must be the same as on
Forms CA-7 and CA-7b.
Block 5: If claiming compensation for any dates detailed in block 4, state total number of hours claimed
for leave without pay and total number of hours of leave. This should be at least 10 hours
unless this is your final claim.
Block 6:
1st Column:
Show full date.
2nd Column:
For each date noted in column 1, state "Y" if you are claiming compensation
for that date and "N'' if you are not.
3rd, 4th,
5th and 6th
Show the number of hours of LWOP, number of hours worked, paid
Columns:
holiday hours, and number of hours of paid leave.
7th Column:
Using the legend provided, indicate the type of leave used.
8th Column:
State the reason you were off work. For each date for which compensation
is claimed, there must be medical evidence supporting entitlement.
Sign and Date Form and Submit to the Appropriate Agency Official.
Instructions for Employing Agency:
Block 7: Verify accuracy of hours and status for each date listed. If challenging entitlement for any date,
attempt to resolve discrepancies prior to submitting claim to OWCP. If discrepancy cannot be
resolved, indicate the specific basis for the challenge in the space provided.
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How to Fill Out Form CA-7a?

Form CA-7a is a one-page document, which mostly consists of free blocks that are supposed to be filled in by an applicant with different types of information. A CA-7a example may be found above, however, in order to fill it out without any mistakes, the application is provided with instructions on how to complete it.

The document can be divided into two parts:

  • Employee Statement

In the first part after filling out the personal information, such as full name, Social Security Number (SSN), and Office of Workers' Compensation Programs (OWCP) File Number, an applicant must indicate the beginning and ending dates covered by this document. These must be the same as on Form CA-7, Claim for Compensation, and Form CA-7b, Leave Buy Back Worksheet.

If a filer is claiming compensation for any dates detailed in the previous part of the document, they must state the total number of hours claimed for leave without pay (LWOP) and the total number of hours of leave. If it is not the final claim, then the number of hours should be at least ten.

The last block of the Employee Statement is presented with columns and each one of them is supposed to be filled out by an employee. In those columns an applicant must indicate:

  1. Full date;
  2. For each date an applicant must state whether they are claiming compensation or not;
  3. The number of hours of LWOP, number of hours worked, paid holiday hours, and number of hours of paid leave;
  4. The type of leave used;
  5. The reason a filer was off work. It's important to remember that medical evidence supporting the entitlement must be provided for each day for which the compensation is claimed.

After a filer has finished filling out Form CA-7a, they are supposed to sign and date it, and then to submit to the Appropriate Agency Official.

Agency Statement/Certification. An agency is supposed to verify two things:

  • The accuracy of hours;
  • The status for each date listed.

If there is a challenging entitlement for any date, an agency should try to resolve discrepancies prior to submitting a claim to OWCP. If the discrepancy cannot be resolved, an agency should indicate the specific basis for the challenge in the space provided in the form.

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