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OMB Control No: 1240-0046	ICR Reference No: 202605-1240-001
Status: Received in OIRA	Previous ICR Reference No: 202502-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Federal Employees' Compensation Act Medical Reports and Compensation Claims
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 06/04/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2026
Responses	279,100	282,353
Time Burden (Hours)	26,648	25,605
Cost Burden (Dollars)	173,740	133,412

Abstract: These forms are utilized for the submission of claims pertaining to wage loss resulting from Federal employment-related injuries. Additionally, they are required for the collection of essential medical documentation to determine whether a claimant is eligible for benefits under the Federal Employees Compensation Act (FECA).

Authorizing Statute(s): US Code: 5 USC 8101 Name of Law: Federal Employees Compensation Act
   US Code: 5 USC 8102 Name of Law: Federal Employees Compensation Act
   US Code: 5 USC 8149 Name of Law: Federal Employees Compensation Act
   US Code: 5 USC 8103 Name of Law: Federal Employees Compensation Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 13637	03/20/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 33766	06/04/2026
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
FECA Medical Report Forms, Claim for Compensation	CA-1331 with CA-1087 enclosure, CA-1332, CA-1305, CA-1090, CA-20, owcp-5c, ca-16, owcp-5b, OWCP-5a, CA-7 revised, CA-17, CA-20, OWCP-5a, OWCP-5b, OWCP-5c	, , , , , , , , , , , , , ,

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	279,100	282,353	-3,253
Annual Time Burden (Hours)	26,648	25,605	1,043
Annual Cost Burden (Dollars)	173,740	133,412	40,328

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Respondents: The number of respondents decreased from 282,353 to 279,100. This decrease in respondents was due to less forms received overall. Responses: The number of responses decreased from 282,353 to 279,100. This decrease in respondents was due to less forms received overall. Burden Hours: The total number of burden hours increased from 25,605 hours to 26,648 hours due to the increased responses for the OWCP-5, CA-16 and CA-1331/CA-1087. Specifically, The number of OWCP-5’s increased from 11,651 to 19,550 The number of CA-16’s decreased from 29,519 to 19,143 The number of CA-1331/CA-1087 increased from 1,062 to 1,540 Burden Hours: The total number of burden hours increased from 25,605 hours to 26,648 hours due to the volume of the increased responses for the OWCP-5, CA-16 and CA1331/CA-1087. Specifically, the number of OWCP-5s increased from 11,651 to 19,550, the number of CA-16s decreased from 29,519 to 19,143, and the number of CA-1331/CA-1087 increased from 1,062 to 1,540. Costs to Respondents or Recordkeepers: Item 13 costs for this submission increased from $133,412 to $173,740 due to an increase in the cost of postal mailing costs, and the hourly rate increase(s) from $28.03 to $32.03 & $20.88 to $23.05. The burden cost increased due to the increase in postage price and the current hourly wage of both the Office and Administrative Support Occupations (Medical report forms are generally completed by administrative support staff based on physician's notes for the signature of the physician) and the National Average Hourly Earnings of Private Production Workers – not seasonal (respondents completing the CA-7 form).

Annual Cost to Federal Government: $1,342,463

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Marcus Sharpless 202 693-0998 sharpless.marcus@dol.gov

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