FECA, Longshore, Black Lung and energy employee program forms from the Department of Labor, with who completes each one and how it reaches OWCP.
The Department of Labor's Office of Workers' Compensation Programs (OWCP) issues the forms on this page for four programs: FECA for federal employees, the Longshore Act, Black Lung benefits for coal miners and EEOICPA for energy employees. For an injured federal employee, physicians meet three forms most: the Duty Status Report (CA-17), the Attending Physician's Report (CA-20) and the Work Capacity Evaluation for musculoskeletal conditions (OWCP-5c). Longshore claims use the LS-1 and LS-204, and Black Lung exams use the CM-988.
On the CA-17, the supervisor completes Side A and the physician Side B, which goes back to the employing agency within 2 days. The CA-20 is uploaded through ECOMP or mailed to OWCP, which pays for it under the OWCP fee schedule. Energy program authorization requests go through the OWCP Web Bill Processing Portal, and the CA-27 opioid request is completed inside it. Spanish versions exist for 5 forms. Vero Documents fills PDF forms like these from the visit note and the chart, and you review and sign.
CA-17Informe de estado de servicio
Reports an injured federal employee's work restrictions and ability to return to regular or modified duty after an injury.
Informe del médico tratante
Attending physician's report of diagnosis, objective findings, causal relationship to employment, disability periods and work limitations for a federal employee's compensation claim.
Evaluación de la capacidad de trabajo Condiciones músculo esqueléticas
Treating physician's assessment of an injured worker's work capacity and physical restrictions (sitting, lifting, reaching, etc.) for an accepted musculoskeletal condition.
Employing agency's written authorization (up to 60 days) for a physician or facility to examine and treat a federal employee for a traumatic injury, with the attending physician's initial report on the reverse.
CA-27Prescriber's certification and letter of medical necessity required for OWCP to authorize opioid prescriptions beyond the initial fill limits for a FECA claimant.
Evaluación de la capacidad de trabajo Condiciones psiquiátricas / psicológicas
Treating physician or psychologist's assessment of an injured worker's capacity to work and restrictions for an accepted psychiatric/psychological condition.
Evaluación de la capacidad de trabajo Condiciones cardiovasculares / pulmonares
Treating physician's assessment of work capacity, physical demand limits and functional class for an injured worker with an accepted cardiovascular or pulmonary condition.
Employer's authorization for a physician of the employee's choice to examine/treat a Longshore Act (or extension) injury, with the physician's initial report of injury and treatment on the reverse.
Attending physician's progress and final (discharge) report on a Longshore Act injury, including disability status and any permanent partial impairment.
Physician's opinion on whether a black lung beneficiary can manage benefit payments in their own interest, used to decide whether to appoint a representative payee.
Treating physician's certification requesting DOL prior approval of durable medical equipment, oxygen and home nursing for a black lung beneficiary (authorization up to one year, renewable).
ILO-based classification of a miner's chest image for pneumoconiosis, used to determine eligibility for black lung benefits.
CM-933bSecond (quality/validation) B-reader rereading of a miner's chest image for black lung claims.
Examining physician's medical and occupational history, physical exam and reasoned opinion on pneumoconiosis, respiratory impairment and causation for a black lung benefits claim.
Reports resting/exercise arterial blood gas results for a black lung claimant under the quality standards of 20 CFR 718.
CM-2907Reports pulmonary function (spirometry) results with tracings for a black lung claimant under 20 CFR 718 Appendix B standards.
Treating physician certifies a face-to-face exam and either requests an in-home assessment or attaches a letter of medical necessity (plan of care) for home health care, nursing home or assisted living for an EEOICPA-covered condition.
Provider's prior-authorization request for medical services (procedures, outpatient services, drugs by HCPCS/CPT/NDC/revenue code) for an EEOICPA claimant's accepted condition.
Prior-authorization request for durable medical equipment for an EEOICPA claimant, supported by the physician's prescription and letter of medical necessity.
Prior-authorization (initial, re-authorization, amendment or correction) of a rehabilitative therapy plan (e.g. PT, OT, speech, chiropractic) for an EEOICPA claimant.
Prior-authorization request for an organ/tissue transplant for an EEOICPA claimant, with the treating physician's letter of medical necessity.
Home health agency's prior-authorization request (initial, re-authorization, amendment) for a home health care service plan for an EEOICPA claimant.
Provider's prior-authorization request for procedures, testing, therapy, DME and other services for FECA, Black Lung and Energy claimants before treatment is rendered.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The attending physician: an MD or DO, clinical psychologist, podiatrist, dentist or optometrist. A chiropractor qualifies only for a subluxation shown on x-ray. The form's instructions say reports from nurse practitioners and physician assistants must be countersigned by a physician. OWCP pays for the CA-20 under its fee schedule, billed on the OWCP-1500, and the report is uploaded through ECOMP or mailed to OWCP.
Within 2 days. The supervisor completes Side A with the job's demands and refers the form to the physician. The physician completes Side B (items 11 to 20) with the employee's work restrictions and ability to return to regular or modified duty, then returns it to the employing agency. The CA-17 also comes in Spanish.
Neither has a public blank form. The employing agency issues the CA-16 for each traumatic injury, authorizing examination and treatment for up to 60 days, and the attending physician completes the report on the reverse. The CA-27, the opioid authorization request and letter of medical necessity, is completed by registered providers inside the OWCP Web Bill Processing Portal.
The DOL-sponsored pulmonary evaluation uses the Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), completed by a DOL-approved diagnostic provider. Test results go on the Report of Ventilatory Study (CM-2907) and the Report of Arterial Blood Gas Study (CM-1159), and a B reader or board-certified or board-eligible radiologist completes the Radiologic Interpretation (CM-933). DOL pays for the DOL-sponsored evaluation under its fee schedule.