Agency:

OWCP-DFEC

Title:

DFEC CA-721, Notice of Law Enforcement Officer's Injury Or Occupational Disease

Form Description:

DFEC CA-721, Notice of Law Enforcement Officer's Injury Or Occupational Disease: This form is used by law enforcement officers to submit a claim for injury or occupational injury. It is also used by the employing organization to file a report, and by the officer's attending physician to provide a medical report.

OMB Control Number:

1215-0116

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