How to Fill Out DOL Form CA-722 (w/Examples) + FAQs

Form CA-722 is the U.S. Department of Labor’s “Acknowledgment of Notice of Recurrence” form, and you fill it out by completing the employee identification block, the recurrence date, the supervisor’s certification of work status and pay, and the agency contact section, then submitting it to the Office of Workers’ Compensation Programs within 10 working days of the employee’s recurrence notice. The form lives inside the Federal Employees’ Compensation Act (FECA) system, and it confirms that your federal agency received the worker’s claim of a recurrence under 20 C.F.R. § 10.5(x). Filing it correctly protects the injured worker’s wage-loss benefits and shields the agency from procedural penalties.

The problem CA-722 solves is a paperwork gap. When a federal employee suffers a recurrence of a prior accepted injury, OWCP needs proof that the employing agency knew about the recurrence and acted on it. Without a clean CA-722, claims stall, pay stops, and supervisors face audit findings under the OWCP Procedure Manual Chapter 2-1400.

According to the DOL FECA Annual Report to Congress, OWCP processed more than 102,000 new and recurrence claims in fiscal year 2025, and roughly 8% of recurrence claims were initially returned for incomplete supervisor forms like CA-722. That delay can cost a worker thousands of dollars in wages.

Here is what you will learn in this guide:

• 📝 How to complete every block of CA-722 line by line, with named examples
• ⚖️ How FECA, 20 C.F.R. Part 10, and the OWCP Procedure Manual control the form
• 💰 How a clean CA-722 protects Continuation of Pay (COP) and wage-loss compensation
• 🚫 The 7 most common mistakes supervisors and claimants make, and how to dodge them
• 📚 Three real recurrence scenarios, ECAB rulings, and 10+ FAQs every filer needs

What Is DOL Form CA-722?

Form CA-722 is a short, one-page acknowledgment used by federal agencies to confirm receipt of a worker’s recurrence notice, which the worker files on Form CA-2a. The acknowledgment tells OWCP that the agency knows the employee claims a return of disability from a previously accepted FECA injury. The form is governed by FECA at 5 U.S.C. § 8118 and by the recurrence rules in 20 C.F.R. § 10.104.

The plain-English point is simple. CA-722 says, “Yes, we got the worker’s recurrence claim, and here is what we know about pay, work status, and witnesses.” The consequence of skipping or fudging the form is a denial or a long delay in benefits, which the worker may have to appeal to the Employees’ Compensation Appeals Board (ECAB).

A real-world example: Maria, a USPS letter carrier, hurt her back in 2022 and returned to limited duty in 2023. In April 2026 her pain returned without a new injury, and she filed CA-2a. Her supervisor must complete CA-722 within 10 working days under the DFEC Procedure Manual 2-0805. A common misconception is that CA-722 is the recurrence claim. It is not. It is the supervisor’s acknowledgment that supports the claim.

Who Files CA-722 and When

The supervisor of record at the federal employing agency files CA-722. Federal employees do not fill it out themselves, but they should review it before submission to catch errors that hurt their claim. The 10-working-day clock begins the moment the supervisor receives the CA-2a or otherwise learns of the recurrence under 20 C.F.R. § 10.110.

If the agency misses the deadline, OWCP can issue a civil penalty under 5 U.S.C. § 8118(c) and refer the matter to the agency’s Inspector General. The consequence for the worker is delayed pay, and the consequence for the supervisor is a documented compliance failure.

A common misconception is that telework or remote employees skip CA-722. They do not. Even fully remote federal workers must have a supervisor file the acknowledgment within the statutory window.

Why CA-722 Matters for Your Claim

CA-722 anchors the recurrence record. OWCP uses the form to verify the date of recurrence, the worker’s pay rate, and the agency’s offer of limited duty, all of which control compensation under 20 C.F.R. § 10.404. Without it, claims examiners send development letters that can stretch processing time past 90 days.

The consequence of a sloppy form is a wage-loss gap. If the supervisor lists the wrong pay rate, OWCP may compute compensation at two-thirds of an incorrect figure, and the worker absorbs the loss until the record is corrected. A real example involves James, a VA nurse whose CA-722 listed his base pay but omitted his night differential, costing him roughly $312 per pay period until reconstruction.

A common misconception is that CA-722 errors can be fixed casually by phone. They cannot. Corrections require a written amended CA-722 with the supervisor’s signature, per the OWCP Procedure Manual 2-0807.

Step-by-Step: How to Complete CA-722

Below is a block-by-block walkthrough. The form is short, but every field carries weight. Each entry must match the worker’s Official Personnel Folder and the prior accepted CA-1 or CA-2 in the OWCP file.

Block 1: Employee Identification

Enter the employee’s full legal name, date of birth, Social Security number, and OWCP file number exactly as they appear on the original injury claim. The OWCP file number is the nine-digit identifier assigned when OWCP first accepted the injury under FECA case-create rules. Mismatched names trigger automatic kickbacks from the OWCP imaging system.

The consequence of a typo here is severe. OWCP’s Integrated Federal Employees’ Compensation System (iFECS) will not link the recurrence to the parent file, and the claim sits in an unmatched queue. The worker may not get a claim number letter for weeks.

A real example: Aisha, a TSA officer, had her last name changed after marriage but never updated her OPM file. Her supervisor used the new name on CA-722, and OWCP rejected the link until a CA-110 amendment cleared. A common misconception is that the SSN alone is enough; iFECS matches on multiple fields.

Block 2: Date of Recurrence

The date of recurrence is the first day the employee could not perform regular duties because of the original injury, not the date of the doctor’s visit. This definition comes straight from 20 C.F.R. § 10.5(x), which separates a recurrence from a new injury or a consequential injury. Get this date wrong and OWCP may reclassify the claim as a new traumatic injury, restarting the entire process.

The consequence of misdating is lost COP. COP only applies to traumatic injuries, not recurrences, so a misclassification can cut off 45 days of full pay or, conversely, deny wage-loss compensation that would have started immediately. The pay difference can exceed $4,500 over six weeks.

A real example: Daniel, a Bureau of Prisons officer, listed the date he saw his orthopedist rather than the date he stopped lifting. OWCP almost reclassified his claim until his union rep submitted a corrected CA-722. A common misconception is that “date of recurrence” equals “date of disability”; they are related but not always identical.

Block 3: Description of Recurrence

Write a short, factual narrative tying the current symptoms to the original accepted condition. Use the original ICD-10 codes from the accepted claim and avoid speculation about new causes. The OWCP Procedure Manual 2-1400 instructs supervisors to record what the worker reported, not what the supervisor believes.

The consequence of editorializing is a credibility hit. If the supervisor writes “employee claims pain but appears fine,” ECAB has held that such notations can be disregarded, and they can also expose the agency to a Whistleblower Protection Act complaint. Stick to facts.

A real example: Priya, a USDA inspector, told her supervisor her knee buckled while walking poultry lines. The supervisor wrote “knee gave out during routine inspection, consistent with 2024 accepted meniscus tear,” and OWCP accepted the recurrence in 21 days. A common misconception is that more detail helps; concise facts beat long opinions.

Block 4: Work Status and Limited Duty

Block 4 asks whether the agency can accommodate the worker’s medical restrictions. Federal agencies have an affirmative duty under 20 C.F.R. § 10.507 and the Federal Employee Reemployment regulations to make reasonable efforts to provide light duty. Mark “yes” only if a written job offer is attached.

The consequence of a false “yes” is sanctions. OWCP can refer the agency to DOL-OIG for fraudulent reporting, and the worker can recover back pay. The consequence of a false “no” is unnecessary wage-loss payments that the agency must later reimburse from its chargeback account.

A real example: A GSA facility manager checked “no light duty available” without consulting HR, even though a sedentary mailroom slot existed. OWCP later found the agency liable for additional chargeback costs of $18,400. A common misconception is that light duty must be in the worker’s exact role; any suitable position counts.

Block 5: Pay Rate Information

List the worker’s pay rate as of the date of recurrence, including locality pay, night differential, Sunday premium, and any regularly recurring overtime. FECA pay-rate rules live at 5 U.S.C. § 8101(4), and 2026 maximum compensation is capped at 75% of the GS-15 step 10 base.

The consequence of underreporting pay is direct: the worker receives less compensation, and recovery requires a formal reconsideration request under 20 C.F.R. § 10.606. Overreporting can trigger a debt collection letter once OWCP audits the file.

A real example: Marcus, a postal mail handler, regularly worked Sunday nights at a 25% premium. His supervisor entered base pay only, costing Marcus about $214 per week until corrected. A common misconception is that overtime never counts; regularly recurring overtime does count under FECA.

Block 6: Witness and Medical Information

Even on a recurrence, OWCP wants to know if anyone witnessed the return of symptoms and which physician is treating the worker. List the doctor’s name, address, NPI, and date of first treatment. The medical narrative still must satisfy the causation standard from Jennifer Atkerson, 55 ECAB 317 (2004).

The consequence of a missing physician name is a development letter under 20 C.F.R. § 10.121, which adds 30 days to processing. Witnesses are not required, but they help when the recurrence happens at work.

A real example: A Department of Energy chemist had a coworker witness her wrist swelling during a routine sample test. Listing the coworker on Block 6 cut OWCP’s development cycle in half. A common misconception is that recurrences need a brand-new diagnosis; they do not, but they need updated medical evidence.

Block 7: Supervisor Certification and Signature

The supervisor signs under penalty of perjury per 18 U.S.C. § 1001. The signature must be a wet signature or a PIV-card digital signature accepted by eCOMP. Stamped or typed names without authentication are routinely rejected.

The consequence of an unauthorized signature is criminal exposure. False statements can lead to fines up to $250,000 and up to five years in federal prison. The consequence to the claim is rejection at intake.

A real example: A USDA regional supervisor delegated her CA-722 signature to a clerk. OWCP rejected the form, and an OIG inquiry followed. A common misconception is that any HR specialist can sign; only the immediate supervisor or an officially designated alternate may sign.

Three Recurrence Scenarios

Below are three named scenarios that show how CA-722 plays out under common federal facts. Each table presents the supervisor’s action and the OWCP outcome.

Scenario 1: Postal Worker With Back Recurrence

Maria, a USPS letter carrier in Cleveland, had an accepted 2022 lumbar strain. In April 2026, after months on full duty, her pain returned while sorting mail. She filed CA-2a the same day.

Supervisor Action	OWCP Outcome
Files CA-722 within 7 days, lists correct pay including night differential	Recurrence accepted in 18 days, wage-loss starts on day 4
Attaches written limited-duty offer signed by station manager	Worker returns to light duty; chargeback minimized
Uses PIV digital signature in eCOMP	Form auto-routes to district office, no rework

Scenario 2: VA Nurse With Shoulder Reinjury

James, a VA registered nurse in Phoenix, had an accepted 2024 rotator cuff tear. In March 2026 the symptoms returned during patient transfer. His supervisor was new and unfamiliar with FECA.

Supervisor Action	OWCP Outcome
Misses the 10-day deadline by submitting CA-722 on day 18	OIG flags agency; claim still processed but flagged
Lists base pay only, omits weekend premium	Compensation underpaid by $186/week until amended
Marks “no light duty” without HR review	Agency absorbs extra chargeback for full wage loss

Scenario 3: TSA Officer With Knee Flare-Up

Aisha, a TSA officer at JFK, had an accepted 2023 meniscus tear. In February 2026 her knee buckled at the screening lane. Her supervisor handled the form correctly.

Supervisor Action	OWCP Outcome
Files CA-722 on day 3, names treating physician with NPI	Claim accepted in 14 days
Confirms no new mechanism, ties symptoms to 2023 ICD-10 codes	OWCP avoids reclassification as new injury
Uses correct OWCP file number from iFECS	Form links to parent case immediately

Mistakes to Avoid

Avoiding the following errors keeps your CA-722 clean and your claim moving. Each mistake carries a measurable cost.

• Missing the 10-working-day deadline: OWCP flags agency noncompliance and may refer to OIG.
• Using a typed signature instead of a wet or PIV digital signature: The form is rejected at intake.
• Leaving Block 5 pay fields incomplete: Worker receives lower compensation than entitled.
• Marking “no light duty” without an HR job-search analysis: Agency absorbs avoidable chargeback costs.
• Confusing recurrence with a new injury: Triggers wrong form (CA-1 instead of CA-2a) and benefit miscalculation.
• Adding personal opinions in Block 3: Damages credibility and may invite a whistleblower complaint.
• Forgetting to list the treating physician in Block 6: Adds a 30-day development letter cycle.
• Using an outdated OWCP file number: Form gets stuck in the unmatched queue inside iFECS.
• Failing to give the worker a copy of the signed form: Violates 20 C.F.R. § 10.111.
• Submitting via fax when eCOMP is available: Slows imaging and creates duplicate records.

Concrete Named Examples

Real names and facts make the rules click. Below are three additional named examples that show CA-722 in action.

Example: Daniel, Bureau of Prisons Officer

Daniel injured his shoulder restraining an inmate in 2023, and OWCP accepted the claim. In February 2026 the pain returned during a routine cell search. His supervisor filed CA-722 within five days, attached a light-duty offer in the control room, and used the eCOMP system. OWCP accepted the recurrence in 16 days, and Daniel kept earning his full GS-8 step 6 pay during recovery.

The lesson is speed plus accuracy. Daniel’s supervisor used the original OWCP file number and the same ICD-10 code from 2023, which let iFECS auto-link the case. The consequence of getting this right was zero wage-loss gap. A common misconception is that recurrences always cost the worker pay; with light duty in place, they often do not.

Example: Priya, USDA Poultry Inspector

Priya had an accepted 2024 meniscus tear. When her knee buckled in March 2026, her supervisor wrote a clean Block 3 narrative, listed her treating orthopedist with NPI, and confirmed no light duty was available because all stations required prolonged standing. OWCP accepted the recurrence and started wage-loss within 21 days.

The lesson is that an honest “no light duty” answer protects the worker. The supervisor documented an HR analysis showing no sedentary roles existed at that facility. The consequence was clean compensation under 20 C.F.R. § 10.404. A common misconception is that agencies always benefit from claiming light duty exists; false claims trigger chargeback reversals.

Example: Marcus, Postal Mail Handler

Marcus had an accepted 2022 lumbar disc injury. In January 2026 his back locked up during night sort. His supervisor underreported pay by leaving out Sunday premium and night differential, costing Marcus $214 per week. After his NALC steward intervened, an amended CA-722 fixed the error, and OWCP issued a retroactive payment.

The lesson is union review pays off. Marcus’s steward used the DFEC pay-rate computation worksheet to flag the gap. The consequence of the original error was a six-week pay shortfall. A common misconception is that OWCP catches all pay errors automatically; it does not.

Dos and Don’ts

Following these dos and don’ts saves time, money, and appeals.

• Do file in eCOMP whenever possible, because it timestamps submissions and prevents lost paperwork.
• Do attach a written light-duty offer if you check “yes” in Block 4, because OWCP needs documented proof of accommodation.
• Do give the employee a signed copy within 24 hours, because 20 C.F.R. § 10.111 requires it.
• Do verify pay components against the SF-50, because base pay alone often understates true earnings.

• Do consult OWCP Procedure Manual 2-1400 for edge cases, because the manual binds claims examiners.

• Don’t editorialize in Block 3, because subjective notes weaken the record and invite ECAB reversals.

• Don’t sign for another supervisor, because 18 U.S.C. § 1001 makes that a felony.
• Don’t list the doctor’s visit date as the date of recurrence, because that triggers misclassification.
• Don’t skip Block 6 medical fields, because missing data yields a 30-day development letter.
• Don’t submit by fax if eCOMP is open, because duplicate filings confuse claims examiners and slow imaging.

Pros and Cons of Filing CA-722 Promptly

Prompt, accurate filing has clear upsides for both worker and agency. Slow or sloppy filing has equally clear downsides.

• Pro: Faster claim acceptance, often within 14–21 days of OWCP receipt under DFEC processing standards.
• Pro: Lower agency chargeback when light duty is documented and offered.
• Pro: Fewer development letters, which means less administrative burden on the supervisor.
• Pro: Stronger record for any future ECAB appeal, because contemporaneous documents carry weight.

• Pro: Worker keeps trust in the agency, which reduces grievances and EEO filings.

• Con: Requires supervisor training on FECA terminology, which costs time.

• Con: Light-duty offers tie up other roles in the agency.
• Con: Pay-rate verification can expose payroll errors that HR must correct.
• Con: Digital signature requirements need PIV cards working at the time of filing.
• Con: Public-facing supervisors can feel pressure if the worker disputes the agency’s Block 4 answer.

Recap of Key ECAB Rulings

The Employees’ Compensation Appeals Board has issued several rulings that shape how supervisors must complete CA-722. These decisions bind OWCP and indirectly bind agencies.

In Jennifer Atkerson, 55 ECAB 317 (2004), ECAB held that a recurrence requires medical evidence connecting current disability to the original accepted condition, and a supervisor’s contemporaneous CA-722 supports that link. In Mary A. Geary, 43 ECAB 300 (1992), ECAB stressed that the burden of proof is on the worker, but supervisor honesty in Block 4 is essential. In Phillip L. Barnes, 55 ECAB 426 (2004), ECAB warned that agency delays in submitting CA-722 cannot be used against the worker.

The consequence of these rulings is straightforward. ECAB rewards clean, fast, factual CA-722 submissions and penalizes both fraudulent and tardy ones. A common misconception is that ECAB reviews only medical issues; it routinely reviews supervisor paperwork too.

Federal vs. State Workers’ Compensation

CA-722 lives in the federal FECA system only. State workers’ compensation laws use different forms, different deadlines, and different appeal paths. Federal contractors covered by the Defense Base Act or Longshore Act use Form LS-202, not CA-722.

The consequence of confusing systems is filing the wrong form, which can blow statutes of limitation. A railroad worker covered by FELA or a Postal Service contractor must use yet other forms. A common misconception is that all federal workers use CA-722; only direct federal employees under FECA do.

FAQs

Is CA-722 the same as CA-2a?

No. CA-2a is the worker’s recurrence claim form. CA-722 is the supervisor’s acknowledgment of that claim, used for internal agency tracking and OWCP routing.

Do I get Continuation of Pay on a recurrence?

No. Under 20 C.F.R. § 10.205, COP applies only to traumatic injuries, not recurrences. You must use sick or annual leave or claim wage-loss compensation while waiting.

Can I file CA-722 on behalf of my supervisor?

No. Only the immediate supervisor or an officially designated alternate may sign under 18 U.S.C. § 1001. Unauthorized signatures expose the signer to felony charges.

Is there a deadline to file CA-722?

Yes. The supervisor must file within 10 working days of receiving the worker’s recurrence notice, per DFEC Procedure Manual 2-0805. Late filing risks OIG referral.

Can I submit CA-722 electronically?

Yes. eCOMP accepts CA-722 with PIV digital signatures, and it is the preferred method because it timestamps the submission and prevents lost paperwork.

Does CA-722 need medical evidence attached?

No. Medical evidence travels with CA-2a, but CA-722 must list the treating physician’s name, address, and NPI in Block 6 to support causation analysis under Jennifer Atkerson.

Can the agency deny my recurrence using CA-722?

No. Only OWCP can accept or deny a claim under 20 C.F.R. § 10.125. The agency’s CA-722 only acknowledges receipt and provides facts.

Will a wrong pay rate on CA-722 hurt me?

Yes. OWCP computes wage-loss compensation from Block 5, so an underreported pay rate directly reduces benefits until the supervisor files an amended CA-722 with corrected figures.

Can my union rep review CA-722 before submission?

Yes. Federal unions like the NALC and AFGE routinely review CA-722 entries, and supervisors should welcome the second set of eyes to avoid rework.

Does CA-722 apply to telework employees?

Yes. Federal teleworkers are still covered by FECA, and supervisors must file CA-722 just as they would for an on-site employee under 20 C.F.R. § 10.5.

Can I appeal if my recurrence is denied?

Yes. You can request reconsideration, an oral hearing, or appeal to ECAB within 180 days of the final decision under 20 C.F.R. § 10.606.

Does CA-722 apply to Postal Service workers?

Yes. USPS employees are federal workers under FECA, and their supervisors file CA-722 the same way other federal supervisors do, using eCOMP or paper submission to OWCP.