When an employee uses their sick or annual leave to cover an injury-related absence from work, they may elect to receive compensation instead.
Dependents: compensation is paid at 2/3 of the employee's base pay if there are no eligible dependents, or at 3/4 with 1 or more dependents.
Item A: enter all three pay rate types and effective dates if applicable. Choose the greatest amount of the three and enter the amount and effective date in Line 1.
Item B: if the employee works a regular schedule, enter the differentials earned weekly.
Minimum claim: please submit a claim for a minimum of 10 hours unless no further claim is anticipated.
Medical documentation: must be provided for all dates claimed.
| Question | Answer |
|---|---|
| Form Name | Form CA-7b |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 41 |
| Avg. time to fill out | 7 min |
| Edition | June 2025 |
| Issuing agency | Department of Labor, Office of Workers' Compensation Programs |
| Where to send | OWCP |
| Other names | CA-7b, CA7b, CA 7b, Form CA-7b, Leave Buy Back Worksheet, LBB Worksheet |
| Official source | Form CA-7b (Rev June 2025), Department of Labor, Office of Workers' Compensation Programs |
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