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supply of the basic forms needed for the proper recording and reporting of injuries. Pamphlet CA-136, obtainable from OWCP, lists the forms to be stocked by the agencies; and also tells where the forms may be obtained.

(b) The basic forms cited in this chapter are: Form No.

Title

(1) CA-1 ....................... Federal Employee's Notice of

Traumatic Injury and Claim for
Continuation of Pay/

Compensation.
(2) CA-2 ........... Federal Employee's Notice of

Occupational Disease and Claim

for Compensation. (3) CA-2............. Notice of Employee's Recurrence of

Disability and Claim for Pay/

Compensation. (4) CA-3 ................ Report of Termination of Disability

and/or Payment. (5) CA-4.......... Claim for Compensation on Account

of Occupational Disease. (6) CA-5 .............

Claim for Compensation by Widow,

Widower and/or Children. (7) CA-50...... Claim for Compensation by Parents,

Brothers, Sisters, Grandparents,

or Grandchildren. (8) CA-6 ............... Official Superior's Report of

Employee's Death. (9) CA-7 ............ Claim for Compensation on Account

of Traumatic Injury. (10) CA-8 ......... Claim for Continuing Compensation

on Account of Disability. (11) CA-16 ......... Request for Examination and/or

Treatment. (12) CA-17.

Duty Status Report. (13) CA-20 ....

Attending Physician's Report. (14) CA-20a ........ Attending Physician's Supplemental

Report (c) Copies of the forms enumerated in this paragraph are available for public inspection at the Office of Workers' Compensation Programs, Employment Standards Administration, U.S. Department of Labor, Washington, D.C. 20211. (40 FR 6877, Feb. 14, 1975, as amended at 41 FR 2, Jan. 2, 1976)

Act constitute the exclusive remedy against the United States for employ. ment related injuries or deaths. The injury or death of an employee gives rise to no right to recover damages from the United States exclusive of the Act. $ 10.23 Penalties.

(a) Any person who makes a false statement to obtain Federal employ. ees' compensation or who accepts compensation payments to which he or she is not entitled is subject to a fine of no more than $2,000 or imprisonment for no more than one year, or both.

(b) Any person charged with the responsibility of making reports in connection with an injury who willfully fails, neglects, or refuses to do so; knowingly files a false report; induces, compels, or directs an injured employ. ee to forego filing a claim; or willfully retains any notice, report, or paper required in connection with an injury, is subject to a fine of no more than $500 or imprisonment for no more than one year, or both.

Subpart B-Notice of Injury and

Claim for Compensation, Administrative Procedures

NOTICE OF INJURY OR DEATH

§ 10.21 Waiver of Compensation rights in

valid. No official superior or other person is authorized to require an employee or other claimant to enter into any agreement, either before or after an injury or death, to waive his or her right to claim compensation under the Act. No waiver of compensation rights shall be valid.

$ 10.100 How to file a notice of injury.

(a) Traumatic injury. Whenever any employee sustains a traumatic injury which he or she believes to have occurred while in the performance of duty, such employee shall immediately give written notice of the injury to his or her official superior. If the employee is unable to give such notice for any reason, such notice may be give by any person with knowledge of the injury on behalf of the injured employee. Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, is approved by the Office for the giving of such notice.

(b) Occupational disease. Whenever an employee has reason to believe that he or she is suffering from an employ. ment related occupational disease or disability which has not been traumatic in onset, such employee or any

§ 10.22 Exclusiveness of remedy.

The benefits provided to employees and to survivors of employees by the

Regulations appear as agency documents which are published daily in the Foderal Register and codified annually in the Codo of Foderal Regulations

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The Federal Register, published daily, is the official publication for notifying the public of proposed and final regulations. It is the tool to use to participate in the rulemaking process by commenting on the proposed regulations. And it keeps people up to date on the Federal regulations currently in effect.

The Federal Register contains many reader's aids—Highlights, Grant Information, list of hearings and Sunshine meetings—which simplify the user's job.

The Code of Federal Regulations (CFR) contains the annual codification of the final regulations printed in the Federal Register. Each of the 50 titles is updated annually.

Subscription Prices:

Federal Register
One year: $75 domestic; $145 foreign
Six months: $45 domestic; $90 foreign

Code of Federal Regulations
One year: $450 domestic; $565 foreign
Single volumes: Individually priced.

ORDER FORM Mail To: Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402

Credit Card Orders Only Enclosed is $

O check,

VISA O money order, or charge to my

Total charges $ - - Fill in the boxes below. Deposit Account No.

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....... Federal Register: $75 per year domestic; $145 foreign

$45 per six-month domestic; $90 foreign

. . . . . . . Code of Foderal Regulations: $450 per year domestic; $565 foreign

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Title 20—Employees'

Benefits

(This book contains Parts 1 to 399)

Part CHAPTER 1–Office of Workers' Compensation Programs,

Department of Labor .......
CHAPTER II-Railroad Retirement Board .........

.. 200

D

1

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........

..........................................

NOTE: Other regulations issued by the Department of Labor appear in 20 CFR Chapters IV, V, VI and VII, 29 CFR Subtitle A and Chapters II, IV, V, XVII and XXV, 30 CFR Chapter I, and 41 CFR Chapters 29, 50 and 60.

CHAPTER 1-OFFICE OF WORKERS'
COMPENSATION PROGRAMS,

DEPARTMENT OF LABOR

CROSS REFERENCE: Employees' and employers' taxes under Federal Insurance Contributions Act and Excise tax on employers under Federal Unemployment Tax Act: See Internal Revenue, 26 CFR Part 31.

SUBCHAPTER A-ORGANIZATION AND PROCEDURES

Part

Page

Performance of functions under this chapter..........

10

25

SUBCHAPTER B-FEDERAL EMPLOYEES' COMPENSATION ACT

Claims for compensation under the Federal Em

ployees' Compensation Act, as amended ............... Compensation for disability and death of noncitizen Federal employees outside the United States............

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36

SUBCHAPTERS C-E (RESERVED)

SUBCHAPTER F-COMPENSATION FOR INJURY, DISABILITY, DEATH, OR ENEMY DETENTION OF EMPLOYEES OF CONTRACTORS WITH THE UNITED STATES

61 62

..........

46

General administrative provisions
Reimbursement of employers, insurance carriers,

or compensation funds .......

SUBCHAPTER G-COMPENSATION FOR INJURY, DISABILITY OR DEATH OF CIVILIAN AMERICAN CITIZENS INCURRED WHILE DETAINED BY OR IN HIDING FROM THE IMPERIAL JAPANESE GOV. ERNMENT

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