Form CA-721A Notice of Law Enforcement Officer's Injury or Occupational Disease

Form CA-721A Notice of Law Enforcement Officer's Injury or Occupational Disease

What Is Form CA-721A?

This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on March 1, 2017 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form CA-721A?
A: Form CA-721A is a Notice of Law Enforcement Officer's Injury or Occupational Disease.

Q: Who uses Form CA-721A?
A: Law enforcement officers use Form CA-721A.

Q: What is the purpose of Form CA-721A?
A: Form CA-721A is used to report an injury or occupational disease suffered by a law enforcement officer.

Q: How do I fill out Form CA-721A?
A: You need to provide personal information, details of the injury or occupational disease, and signed statements on Form CA-721A.

Q: Is Form CA-721A mandatory?
A: Yes, as a law enforcement officer, it is mandatory to submit Form CA-721A to report any injury or occupational disease.

Q: What should I do after filling out Form CA-721A?
A: After filling out Form CA-721A, you should submit it to your employing agency and keep a copy for your records.

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Form Details:

  • Released on March 1, 2017;
  • The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CA-721A by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.

Download Form CA-721A Notice of Law Enforcement Officer's Injury or Occupational Disease

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