Form CA-7A at a glance
What it is: Form CA-7A, the Time Analysis Form, is used when claiming FECA compensation, including repurchase of paid leave.
Who signs: The form has a Signature of Claimant with a Date Signed, and a Signature of Agency Official with a Date Signed.
The Time Analysis Form must be used when claiming compensation for more than one consecutive period of leave.
A filled-in Form CA-7A example: a federal employee claims two days of leave without pay
How to fill out Form CA-7A, box by box
Blocks 1, 2 and 3: employee, SSN and OWCP File Number
Blocks 1, 2, and 3 are self-explanatory: enter the Name of Employee (Last, First, Middle), the SSN and the OWCP File Number.
Block 4: Period Covered by This Form
In Block 4, indicate the beginning and ending dates covered by this form. These must be the same as on Forms CA-7 and CA-7b.
Block 5: Total Hours Claimed
In Block 5, if claiming compensation for any dates detailed in block 4, state the total number of hours claimed for leave without pay and the total number of hours of leave. This should be at least 10 hours unless this is your final claim.
Block 6: dates, hours, type of leave, reason and Totals
In Block 6, 1st Column: show the full date.
In Block 6, 2nd Column: for each date noted in column 1, state "Y" if you are claiming compensation for that date and "N" if you are not.
The 3rd, 4th, 5th and 6th show the number of hours of LWOP, number of hours worked, paid holiday hours, and number of hours of paid leave.
7th Column: using the legend provided, indicate the type of leave used.
In the Type of Leave Used column, use codes "S" = Sick, "A" = Annual, "O" = Other. If Compensation is claimed for date, indicate "Yes" in the Compensation Claimed column.
8th Column: state the reason you were off work. For each date for which compensation is claimed, there must be medical evidence supporting entitlement.
Signature of Claimant and Date Signed
Sign and Date Form and Submit to the Appropriate Agency Official. Enter the Date Signed with the Signature of Claimant.
Block 7: the employing agency
Instructions for Employing Agency, Block 7: verify accuracy of hours and status for each date listed. If challenging entitlement for any date, attempt to resolve discrepancies prior to submitting claim to OWCP. If discrepancy cannot be resolved, indicate the specific basis for the challenge in the space provided.
More rules for Form CA-7A
Please carefully read the instructions on reverse before filling out this form.
Sources
[1] Form CA-7A (June 1996), Time Analysis Form, U.S. Department of Labor, Office of Workers' Compensation Programs (the Official source link on this page).
