source: FOIAVistA/tag/r/ASISTS-OOPS/OOPSPC70.m@ 1764

OOPSPC70 ;HIRMFO/YH-Instructions for Completing Form CA-1 (PART 1) ;5/7/98
 ;;2.0;ASISTS;;Jun 03, 2002
EN1 ;RESET PRINTRA, SET PAGE SIZE (PORTRAIT) AND PCL PICTURE FRAME 8 1/2"*11"
 W !,$CHAR(27),"E",$CHAR(27),"&l1E",$CHAR(27),"*c5952x7920Y",$CHAR(27),"%0B",$CHAR(27),"&s1#C"
 W !,"IN;SP1;IP;PW.3;SC0,22,0,29,1;"
 W !,"DT#,1;SD1,277,2,1,4,10,5,0,6,2,7,23;PU.5,28.3;LBInstructions for Completing Form CA-1#;PU.5,28.1;PD21,28.1;"
 W !,"SD1,277,2,1,4,9,5,0,6,0,7,16901;PU.5,27.6;LBComplete all items on your section of the form. If additional space is required to #;"
 W !,"LBexplain or clarify any point, attach a supplemental#;"
 W !,"PU.5,27.3;LBstatement to the form. Some of the items on the form which may require #;"
 W !,"LBfurther clarification are explained below.#"
 W !,"FT10,10;PU.5,26.5;RA21,27;EA21,27;PU.6,26.6;LBEmployee (Or person acting on the employees' behalf)#;"
 W !,"PU.5,26.1;SD1,277,2,1,4,9,5,0,6,2,7,23;LB13) Cause of Injury#;"
 W !,"PU11,26.1;LB15) Election of COP/Leave#;SD1,277,2,1,4,9,5,0,6,0,7,16901;"
 W !,"PU.5,25.7;LBDescribe in detail how and why the injury occurred. Give#;"
 W !,"PU11,25.7;LBIf you are disabled for work as a result of this injury and filed#;"
 W !,"PU11,25.4;LBCA-1 within thirty days of the injury, you may be entitled to receive#;"
 W !,"PU.5,25.4;LBappropriate details (e.g.: if you fell, how far did you fall and in#;"
 W !,"PU11,25.1;LBcontinuation of pay (COP) from your employing agency. COP is#;"
 W !,"PU11,24.8;LBpaid for up to 45 calendar days of disability, and is not charged#;"
 W !,"PU11,24.5;LBagainst sick or annual leave. If you elect sick or annual leave#;"
 W !,"PU11,24.2;LByou may not claim compensation to repurchase leave used#;"
 W !,"PU11,23.9;LBduring the 45 days of COP entitlement.#;"
 W !,"PU.5,25.1;LBwhat position did you land?)#;"
 W !,"SD1,277,2,1,4,9,5,0,6,2,7,23;PU.5,24.5;LB14) Nature of Injury#;SD1,277,2,1,4,9,5,0,6,0,7,16901;"
 W !,"PU.5,24.1;LBGive a complete description of the condition(s) resulting from#;"
 W !,"PU.5,23.8;LByour injury. Specify the right or left side if applicable (e.g.,#;"
 W !,"PU.5,23.5;LBfractured left leg: cut on right index finger).#;"
 W !,"PU.5,22.6;RA21,23.1;EA21,23.1;SD1,277,2,1,4,9,5,0,6,2,7,23;PU.6,22.7;LBSupervisor#;SD1,277,2,1,4,9,5,0,6,0,7,16901;"
 W !,"PU.5,22.1;LBAt the time the form is received, complete the receipt of notice of#;"
 W !,"PU11,22.1;SD1,277,2,1,4,9,5,0,6,2,7,23;LB33) First date medical care received#;SD1,277,2,1,4,9,5,0,6,0,7,16901;"
 W !,"PU.5,21.8;LBinjury and give it to the employee. In addition to completing#;"
 W !,"PU.5,21.5;LBitems 17 through 39, the supervisor is responsible for obtaining#;"
 W !,"PU11,21.6;LBThe date of the first visit to the physician listed in item 31.#"
 W !,"PU.5,21.2;LBthe witness statement in item 16 and for filling in the proper codes#;"
 W !,"PU.5,20.9;LBin shaded boxes a, b, and c on the front of the form. If medical#;"
 W !,"SD1,277,2,1,4,9,5,0,6,2,7,23;PU11,20.8;LB36) If the emloying agency controverts continuation#;"
 W 1,"PU11.5,20.4;LBof pay, state, the reason in detail#;"
 W !,"SD1,277,2,1,4,9,5,0,6,0,7,16901;PU.5,20.6;LBexpense or lost time is incurred or expected, the completed form#;"
 W !,"PU.5,20.3;LBshould be sent to OWCP within 10 working days after it is received.#;"
 W !,"PU.5,19.5;LBThe supervisor should also submit any other information or#;"
 W !,"PU.5,19.2;LBevidence pertinent to the merits of this claim.#;"
 W !,"PU11,19.9;LBCOP may be controverted (disputed) for any reason; however,#;"
 W !,"PU11,19.6;LBthe employing agency may refuse to pay COP only if the#;"
 W !,"PU11,19.3;LBcontroversion is based upon one of the nine reasons given#;"
 W !,"PU11,19;LBbelow:#"
 D ^OOPSPC71
 W !,$CHAR(27),"&r0F",$CHAR(27),"%0A" Q