Use this as a private worksheet
Keep federal employee claim records separate from ordinary state workers’ compensation materials. This is not an official agency or court form.
Federal file
- ☐ Agency/employer: ______________________________
- ☐ OWCP claim number: ______________________________
- ☐ Federal form(s): ______________________________
- ☐ Medical evidence: ______________________________
- ☐ Work-status notes: ______________________________
- ☐ OWCP correspondence: ______________________________
Privacy reminder
Keep sensitive medical, wage, claim-number, and employment information private. Share it only with appropriate official agencies, licensed professionals, insurers, treating providers, or other people who legitimately need it for the claim.