I hereby claim medical treatment if needed and up to 45 days Continuation of Pay if disabled from work. 

 

I certify that the information provided above is true and accurate to the best of my knowledge and belief. Any person who knowingly makes any false statement, 

misrepresentation, concealment of fact, or any other act of fraud, to obtain compensation as provided by the FECA, or who knowingly accepts compensation to which that 

person is not entitled is subject to civil or administrative remedies as well as criminal prosecution and may, under appropriate criminal provisions, be punished by a fine or 

imprisonment, or both. In addition, a state or federal criminal conviction for FECA fraud will result in termination of all current and future FECA benefits. I understand that by 

signing this form, I authorize any physician or hospital (or any other person, institution, corporation, or government agency) to furnish any desired information to the U.S. 

Department of Labor, Office of Workers’ Compensation Programs (or to its official representative).This authorization also permits any official representative of the Office to 

examine and to copy any records concerning me.

Notice of Recurrence U.S. Department of Labor 

Office of Workers' Compensation Programs

Employee: Complete Part A below if you experienced a recurrence as defined by OWCP on page 4 of this form. 

Employing Agency (Supervisor or Compensation Specialist): Complete Part B. 

Note: Persons are not required to respond to this collection of information unless it displays a currently valid OMB 

control number.

OMB No. 1240-0009 

Expires: 01/31/2027

Part A - Employee

1. Name of employee (Last, First, Middle Initial) 2. Social Security Number 3. OWCP file number for 

original injury

4. Date of Birth Mo./Day/Yr.

Male Female

5. Sex 6. Home telephone 

7. Home mailing address (include street address, city, state, and ZIP code). 

See instructions for address requirement. 

City State Zip Code

8. Dependents

Spouse

Child/Children under 18 years

Other, e.g., qualifying student under age 23

9. Name and Address of Employing Agency 

at time of original injury (number, street, city, state, ZIP code)

10. Name and Address of Employing Agency at time of recurrence, if 

other than shown in 9. If you are no longer employed with the 

Federal Government, complete Part C also.

11. Date and Hour 

of original injury 

(Mo./Day/Yr.)

12. Date and Hour 

of recurrence 

(Mo./Day/Yr.)

13. Date and Hour stopped 

work after recurrence 

(Mo./Day/Yr.)

14. Date and Hour pay stopped 

after recurrence 

(Mo./Day/Yr.)

15. Date and Hour 

returned to work 

(Mo./Day/Yr.)

16. Are you claiming? 

Check both if applicable. 

Time Loss From Work

Medical Treatment 

17. Date of first medical treatment 

following recurrence 

(Mo./Day/Yr.) 

18. Name and address of treating physician

19. After returning to work following the original injury, were you in any way limited in performing your usual duties? 

(If so, explain. Also state how long these limitations continued.) Yes No

20. Describe your condition since you returned to work, including the nature and frequency of all medical treatment received.

21. Describe how and when the recurrence happened. Explain why you believe your current condition is related to the original injury.

22. Describe all injuries and illnesses which you suffered between the date you returned to work after the original injury, and the date of 

recurrence. Arrange for the submission of all relevant medical records.

23. Signature of employee 24. Date (Mo./Day/Yr.)

If you have a disability and are in need of communication assistance (such as alternate formats or sign language interpretation), accommodations and/or 

modifications, please contact OWCP. See form instructions for REQUESTS FOR ACCOMMODATIONS OR AUXILIARY AIDS AND SERVICES. CA-2a (01/2024)
36. Did the employee receive medical care at an agency facility due to 

the recurrence? 

If so, please attach all relevant medical records.

CA-2a (Rev. 01/2024)

Part B - Federal Employing Agency

25. Name and address of reporting office (include street address, city, state and ZIP Code) OWCP Agency Code

City State Zip OSHA Site Code

City State Zip

26. Employee's duty station (include street address, city, state, and ZIP Code) 27. Date of first return to 

FULL-TIME REGULAR duty 

following original injury 

 Mo./Day/Yr.

28. Regular work hours

From: To:

29. Regular work days

Sun. Mon. Tues. Wed. Thurs. Fri. Sat.

30. Date of injury Mo./Day/Yr. 31. Date of 

recurrence

Mo./Day/Yr. 32. Date stopped 

work after 

recurrence

Mo./Day/Yr.

Time:

33. Date pay 

stopped after 

recurrence

Mo./Day/Yr. 34. Dates COP 

paid for 

recurrence

Mo./Day/Yr.

From:

To:

35. Date returned 

to work after 

recurrence

Time:

Mo./Day/Yr.

Yes

No

37. At the time of the injury did your agency authorize medical 

treatment on Form CA-16? Yes

No

38. After the original injury, did you make any accommodations or adjustments in the employee's regular duties due to injury-related limitation?

Yes No If so, provide full details.

39. After return to work, did the employee sustain any other injury or illness which affected performance of his or her duties? If so, provide full 

details.

40. Please review the statements made by the employee in Part A of this form and provide any relevant comments and additional information.

A supervisor or compensation specialist who knowingly certifies to any false statement, misrepresentation, concealment of fact, etc., 

in respect to this claim may also be subject to appropriate criminal prosecution.

41. Signature of Supervisor or Compensation Specialist 

(at time of recurrence)

42. Title 43. Work phone 44. Date (Mo./Day/Yr.)
5. Do you claim compensation for lost wages?

CA-2a (Rev. 01/2024)

Part C - Employee

(To be completed by the employee if not employed with the Federal Government at the time of the claimed recurrence)

1. For all jobs held since you left the job held when the initial injury occurred, list the full name and address of your employers, and the inclusive 

dates of employment. Include any self-employment.

2. For all jobs listed in item 1 above, provide your job title, nature of duties performed, number of hours worked per week and rate of pay.

3. Describe all educational and/or vocational training received since your original injury. Include any licenses or certificates earned.

4. What was your rate of pay if you stopped work due to this recurrence?

$ per

6. Have you received any pay during the period claimed?

If so, how much and from what source?

7. Signature of Employee 8. Date (Mo./Day/Yr.)

Yes No

Yes No

If so, for what period? through
• After the employee has completed Part A, promptly complete Part B and submit the form to OWCP, unless: the claimant is still receiving 

continuation of pay (COP); the recurrence is for medical care only and the claim is still open; or the claimant is currently requesting neither 

wage-loss compensation nor payment of medical expenses. In these instances, file the form in the Employee Medical Folder. 

• If COP is being paid, obtain medical evidence using Form CA-17, "Duty Status Report", as often as circumstances indicate. 

• For recurrences of disability which continue after the 45 days of COP have expired or which involve occupational illness, instruct 

the employee to file Form CA-7.

CA-2a (Rev. 01/2024)

INSTRUCTIONS FOR COMPLETING FORM CA-2a NOTICE OF RECURRENCE

DEFINITION OF RECURRENCE

A Recurrence of the Medical Condition is the documented need for additional medical treatment after release from treatment for the workrelated injury or condition. Continuing treatment for the original condition is not considered a recurrence. 

 

A Recurrence of Disability is a work stoppage caused by: 

• A spontaneous return of the symptoms of a previous injury or occupational disease without intervening cause; 

• A return or increase of disability due to a consequential injury (defined as one which occurs due to weakness or impairment caused by 

a work-related injury); or 

• Withdrawal of a specific light duty assignment when the employee cannot perform the full duties of the regular position. This 

withdrawal must have occurred for reasons other than misconduct or non-performance of job duties. See 20 C.F.R. 10.5 (x). 

 

IF A NEW INJURY OR CONDITION DUE TO OCCUPATIONAL EXPOSURE OCCURS, AND DISABILITY OR THE NEED FOR MEDICAL 

CARE RESULTS, A NEW FORM CA-1 OR CA-2 SHOULD BE FILED. This is true even if the new incident involves the same part of the body 

as previously affected.

INSTRUCTIONS FOR EMPLOYEE

• Review the definition of "recurrence" given above. If you believe that you have sustained a recurrence, complete Part A of this form. Attach 

a separate sheet of paper if needed to provide full details. Please ensure you provide your current address at the time of your claimed 

recurrence. The address is to include: the House Number and Street Name, City/Town, State, and Zip Code. 

For the FECA program to effectuate proper claims management, a FECA claimant should provide the home address where he or she 

resides. 

• If you worked for the Federal Government at the time of the recurrence, submit Form CA-2a to your employing agency. If you no 

longer work for the Federal Government, complete Parts A and C of this form and submit all materials directly to the Office of 

Workers' Compensation Programs (OWCP). 

• If you are claiming a recurrence of disability for an occupational illness, or if all 45 days of continuation of pay (COP) have been 

used, you may claim wage loss on Form CA-7. The OWCP will pay compensation if the claim is approved. 

• Arrange for your attending physician to submit a detailed medical report. The report should include: dates of examination and 

treatment; history as given by you; findings; results of x-ray and laboratory tests; diagnosis; course of treatment; and the treatment 

plan. The physician must also provide an opinion, with medical reasons, regarding causal relationship between your 

condition and the original Injury. Finally, the physician should describe your ability to perform your regular duties. If you are 

disabled for your regular work, the physician should identify the dates of disability and provide work tolerance limitations. 

• If other physicians treated you after you returned to work following the original injury, obtain similar medical reports from each of them.

INSTRUCTIONS FOR EMPLOYING AGENCY

Privacy Act 

The Privacy Act of 1974 as amended, (5 U.S.C. 552a), and the Federal Employees’ Compensation Act, as amended and extended (5 U.S.C 

8101, et. seq) authorizes collection of this information. The information will be used to determine continuing entitlement to benefits. Furnishing 

the requested information is required for a claimant to obtain or retain a benefit. Failure to provide the information may result in the delay of a 

claim or payment of benefits, or may result in an unfavorable in a delay of a claim or payment of benefits, or result in an unfavorable decision or 

reduced levels of benefits. Additional disclosures of this information may be to: (1) to determine eligibility for and the amount of benefits payable 

under the FECA, and may be verified through computer matches or other appropriate means; (2) to the Federal agency which employed the 

claimant at the time of injury in order to verify statements made, answer questions concerning the status of the claim, verify billing, and to 

consider issues relating to retention, rehire, or other relevant matters; (3) to other Federal agencies, other government entities, and to privatesector agencies and/or employers as part of rehabilitative and other return-to-work programs and services; (4) to physicians and other 

healthcare providers for use in providing treatment or medical/vocational rehabilitation, making evaluations for the Office, and for other purposes 

related to the medical management of the claim; and (5) to Federal, state and local agencies for law enforcement purposes, to obtain 

information relevant to a decision under the FECA, to determine whether benefits are being paid properly, including whether prohibited dual 

payments are being made, and, where appropriate, to pursue salary/administrative offset and debt collection actions required or permitted by 

the FECA and/or the Debt Collection Act.

Public Burden Statement 

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Public reporting 

burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching 

existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any 

comments regarding this estimate or any other aspect of this information collection, including suggestions for reducing this burden, please send 

them to the Department of Labor, Office of Workers' Compensation Programs, Room S-3229, 200 Constitution Avenue, N.W. Washington, D.C. 

20210. DO NOT SEND THE COMPLETED FORM TO THIS OFFICE. 
Requests for Accommodations or Auxiliary Aids and Services 

If you have a disability, federal law gives you the right to receive help from the OWCP, DFEC, in the form of communication assistance, 

accommodation(s) and/or modification(s) to aid you in the FECA claims process. For example, we will provide you with copies of documents in 

alternate formats, communication services such as sign language interpretation, or other kinds of adjustments or changes to accommodate your 

disability. please contact your OWCP claims examiner to ask about this assistance. 

CA-2a (Rev. 01/2024)