Dol-Owcp Forms - Postal Reporter Page 4
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4Privacy Act
In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you are here by notified
that: (1) The Federal Employees' Compensation Act, as amended and extended (5 U.S.C. 8101,
et seq.) (FECA) is administered by the Office of Workers' Compensation Programs of the U. S .
Department of Labor, which receives and maintains personal information on claimants and their
immediate families. (2) Information which the Office has will be used to determine eligibility for
and the amount of benefits payable under the FECA, and may be verified through computer
matches or other appropriate means. (3) Information may be given 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. (4) Information may also be given to other Federal agencies,
other government entities, and to private-sector agencies and/or employers as part of
rehabilitative and other return-to-work programs and services. (5) Information may be disclosed
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. (6) Information may be given 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. (7) Disclosure of the
claimant's social security number (SSN) or tax identifying number (TIN) on this form is
mandatory. The SSN and/or TIN, and other information maintained by the Office, may be used
for identification, to support debt collection efforts carried on by the Federal government, and for
other purposes required or authorized by law. (8) Failure to disclose all requested information
may delay the processing of the claim or the payment of benefits, or may result in an unfavorable
decision or reduced level of benefits.
Note: This notice applies to all forms requesting information that you might receive from
the Office in connection with the processing and adjudication of the claim you filed under
the FECA.
CA-7 Page 4 (Rev.05-11)
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