Sign California Claim Now

Owcp 1168 2015-2019 Form

in this video we're gonna be covering how to fill in your CA 7 CA 7 a CA 7 B in your direct deposit form SF 1199 a there's a bit of confusion when it comes to the claim for compensation CA 7 form and I'm not 100% sure if it's confusion or it's just a bit intimidating so what you're gonna find out is that we're quite literally just filling in the boxes take each box one at a time and what you'll find is that this is very easy to fill out so obviously we would start with the section 1 and then go through each question until we get the end so here we go name last name first first name second middle initial B is your mailing address very easy you do want to make sure that of course your handwriting is legible you don't want to make a mistake it could cause delay in your payment if you're submitting CA sevens you definitely will have an OWCP file number case number you're gonna go ahead and put that number in this box here email address is optional the very fact that you're trying to claim compensation in this case I would put your email address and they're probably not going to contact you on the email as most of their documentation has to go out by mail but you never know so if you'd like go ahead and put that in date of injury sometimes people do forget their date of injury if you don't remember it Oh wcp file number or claim number and the date of injury are gonna be on your approval letter from OWCP so if you do forget it go ahead and get it from there your social is necessary so make sure you put it in there F telephone or fax number most people are not using fax these days if you do have one put it in why not telephone number doesn't necessarily have to be your home number it just has to be a home number cell number whatever is the most easy to contact you on so that's section one very very easy moving along to section 2 remember what I said a couple minutes ago all we're gonna do is go box by box and that's it we're gonna answer what we answer and follow the directions so compensation is claimed for what what did you use or what are you trying to get compensation for in this scenario in section two we have four options leave without pay LWOP leave buyback see other wage loss specified type such as downgrade loss of night differential etc the scheduled award most folks are gonna be checking off boxes a and B and because of that we're largely gonna be talking about what to do in those scenarios for the most part you're gonna be submitting these for each payroll period if your payroll period is once a week then you'll submit these once a week it's usually two-week period so you'll submit these every two weeks for the purpose of our example we're gonna use leave by that so as I told you from the beginning we're gonna be checking off boxes and filling in dates for the most part so in this scenario we would check leave by back again just for example purposes we're gonna use a two-week period now that we have our date range in we have to answer the next question was this intermittent or not if you worked even one hour a half-day one day any amount of time during the time period during the date range that you entered you need to click yes so we're gonna go ahead and do that that will allow me to show you how to use every form in the seven series so we're gonna head and click yes now if you did not work at all obviously you'd click no and then follow the instructions here go to section three and complete form seven B so we are gonna complete that form just not right now we're gonna finish this one first I want to show you how to fill out the 7a we're gonna click on yes it was intermittent but like I said if you do not work at all during the time period that you entered in the inclusive date range then you would check off no well just like I said earlier all you're gonna do is check off boxes enter date ranges and follow the direction so here's a set of directions go to section 3 and we also need to fill out form CA 7b we answered yes so if intermittent complete form 7a the time analysis sheet we are going to do that once we're done here moving along to section 3 this is section 3 in section 3 they're asking you if you've had any other income outside your federal job you must report any in all earnings from employment even outside of your federal job include any employment for which you received a salary wages income sales commission or payment of any kind during the periods claimed in section 2 which in our example is January 1st to January 14th include self-employment odd jobs involvement and business enterprises as well as service in the military it's important to note what they say here fraudulently concealing employment or failing to report income may result in forfeiture of compensation benefits and/or criminal prosecution have you worked outside your federal job for the periods claimed in section 2 if so refer to the instructions which provide further clarification if you did you need to check yes you'll need to put the name of the business and the address the dates that you work and the type of work it is if you check yes you'll put that information here now for the most part when people get hurt especially with ca1 injuries they're hurt to the point where they actually can't work another job because they've been injured so 90% of the time folks check No so we've checked either yes or no now we have to follow the direction which says go to section 4 section 4 is this the first CA 7 claim for compensation you have filed for this injury let's answer the question if it's yes which it most likely is if you're watching this video yes complete sections 5 through 7 in form SF 1199 a the direct deposit signup form which I'm gonna show you how to fill in at the end of this video this is not your first time filling out this form you're gonna check no and then read the directions right here if changes to dependent status direct deposit information or if a claim has been filed with the US Civil Service Retirement another federal time and disability law or with the Department of Veterans affair complete sections 5 through 7 or a new SF 1199 a if no complete section 7 this point we would make our selection here yes or no and then follow the instructions we're gonna go along the lines that this is our first time filling out this form however if it's not select no just remember if you select no you'll have to select yes or no here and follow those instructions as well section 5 for the most part most of the folks who come through our facilities have dependents so I'm gonna show you how to fill out this section you need to go ahead and list your dependents we're gonna go ahead and just use John Doe jr. who's social is and date of birth January 2018 relationship living with you yes or no you check the box for dependents not living with you complete items a and B below so just go ahead and try that out no are you making support payments for dependent noted above on your attachments yes if yes you need to enter the name of the person you making support payments to in this case we're just gonna use Jane Doe you need to enter the address city state and zip code once you've completed that you move on to the next box B be where support payments ordered by a court if yes check yes if no check no if yes attach a copy of the court order once you've completed that section move on to section 6 section 6 is right here was will there be a claim against a third party if yes select yes if no select no have you ever applied for or received disability benefits from the Department of Veteran Affairs if yes you'll check yes here but the claim number in full address of VA office where claim was filed and then enter the nature of disability and monthly payment be sure to do both if no it makes it much easier you select no and move on have you ever applied for received payment under any federal retirement or disability law if yes select yes add the claim number enter the date the annuity began amount of monthly payment and then your Retirement System select which one of these it was and move on if no select no now you've already completed page one of the CA seven you'll have to go ahead and read this information prior to signing you always want to make sure you know what you're signing isn't that correct once you have read that but your signature add your date now if we scroll down what you'll notice is there's a second page there's a third page on page four is Privacy Act information page three our instructions and page two is going to be filled out by your employing agency nothing to worry about there they'll take care of that once you've completed seven we scroll back up top we were instructed to fill out the 7b and the 7a so just to kind of go in order we're gonna go to the 7a next so just like the seven the time analysis form or if we check the bottom right hand corner of the form form 7a is just filling in one box at a time taking things nice and slow so name of employee Social Security number required OWCP case number that's required and periods covered by this form the period in box 4 has to match what you put in section two so in this scenario we use January first over here we have to use January first and the end date was January 14 if these do not match these forms will get rejected box 5 total hours claimed he used LWOP you put those in there if you're trying to do a leave buyback you put those hours in there it is possible to both especially on your first one the reason why we have to fill out the 7a is because on the seven hour time was in intermittent if you have intermittent time you must fill out a time analysis form which is the 7a okay so let's go back there in this scenario what you would do here is enter the dates I've gone ahead and entered all the dates as you can see here on the left hand side I cut all that time out because it was boring now what you're simply need to do is go line by line January first are you claiming compensation for this day or not well in this case we're not so if no you don't have to do anything else we move on to the next day January 2nd are we claiming compensation for this day yes we are on this day we used four hours of LWOP and worked for hours reason for visit medical doctor appointment it's important to note that for every day that you're claiming you do need to have medical documentation for or physical therapy notes so in our office is what we do every time you come to our office we're gonna produce some sort of a form for you if you're meeting with a medical provider you'll get a CA 20 in addition to the CA 20 the doctor will complete what are called soap notes in most cases the soap notes are gonna be overkill for what OWCP is looking for in order to process this form so we'll let you leave with a CA 20 and upload the soap notes directly to OWCP via e comp on days when you come to our office and you're doing physical therapy we will generate a physical therapy progress note you will also leave with that progress note as I've said previously in another video we give you two copies of everything that we produce one is for your records and one is to give to your agency everything that we produced will also get uploaded via ecomp to OWCP moving on to January third is compensation being claimed yes so let's say in this scenario you worked four hours and you used four hours of leave well what type SiC annual or other if you're not using Adobe like what I'm using here what you'll need to do is put a s in this box for sick a for annual Oh for other those directions as you can see are right here and just as an example on this day we went to physical therapy remember what I said for every day that you're claiming compensation you have to have a note or some sort of documentation that proves that you actually want to therapy as you can see this is not too difficult what you would do is just go right down the line so we have first second third fourth fifth six well what happened to the seventh well that was a Sunday eight nine ten and so on okay for the days that you will be asking for compensation you need to write or check yes you will enter the amount of time that you used the amount of time that you worked and enter the reason for leave use their example is doctor's visit therapy etc okay now on the days where you're not claiming compensation it's because you worked that entire day now remember the reason why we're filling out this form in the first place it's because on the seven you checked off that your time was intermittent that means that you worked some days now let's go back to the seven briefly here we are back on the first page of the seventh now if you do not have any intermittent days on or off you would have checked no it means that there would be no requirement to fill out the seven a and they would just pay you your workers compensation rate if you're completely out of work and you have a see a seventeen taking you off of work there's no requirement to fill out a seven a and they'll just pay you your workers compensation rate for the days that you put in the inclusive date range which in our example is January for us through January 14 let's cut back to the CA seven a once you've completed all the day's in that work period still total up the hours for each column you'll go ahead and sign what the date that you signed then someone that your agency will go ahead and verify this information with any exceptions which they'll list here then they'll sign and date it at that point they'll get it over to injury comp or ecomp page two are the instructions for completing the 7a which at this point we're done now we did decide to go ahead and use leave at some point sicker annual time so we do have to fill out a 7b let's go ahead and cut to the 7b here we have the leave buyback worksheet certification an election we know that this is the 7b because it says it right here in the bottom right hand corner this is the easiest form you're gonna fill out quite literally you put your name in OWCP file number your Social Security and the dates that you put on this 7 which is January 1st through January 14 once you've completed the employee statement which is a through D shown here you are done it's easiest form let's look at how you know you're done well have to come down here to the instructions you're required to complete form seven if necessary fill out form 7a submit both form 7 and 7a if 7 is appropriate the agency will provide you with an estimate of workers compensation benefits do the amount owed to the agency in order for the leave to be restored minus the amount you must pay the agency so they scroll down just a little bit more what we see is that the agency is required to fill everything out from section 1 on now once they've completed that and they send it back to you at that point now you have a decision to make I do not want to report just to leave at this time I do want to repurchase the leave at this time a lot of people have a hard time understanding this because this is a bit confusing why is this a leave buyback let me go ahead and show you something on a separate piece paper just as an example let's say you make $100 per day when you use sicker annual time it pays at a hundred percent meaning you will receive a check for $100 workers compensation pays that either sixty six percent if you have no dependents meaning you don't claim them anyone except for yourself in your tax return or seventy five percent if you have even just one dependent well since you've used your sick or annual time you've been to pay two hundred dollars now you want to get that time back but the workers comp rate for that same day is seventy five dollars so in order to get that time back you'll need to pay the $25 difference paying the difference back is why this is called a buy back said differently if you've used one thousand dollars worth of sick or annual time you will need to pay back your agency two hundred fifty dollars to get your hours back because the pay rate for workers comp would have only been seven hundred fifty dollars for that same time period and you received an overpayment of two hundred fifty dollars it is not an absolute requirement for you to buy back your time the greatest portion of people that I come in contact with choose to buy back their time because it benefits them in the long run however a small portion of people say I've already used that money I don't want to have to do a buyback and pay the agency the overpayment if that's the case when we go back to the seven B after your agency has filled in their portion of the form in this area here they'll tell you what you owe them if you feel as though you want to get your time back it's quite simple all you would need to do is check L if you do not want to repurchase your leave at that time check off K very very simple okay I do not want to purchase the time back l I do want to purchase the time back well at this point folks we have completed all the forms and now I just need to talk about how to fill out our direct deposit form here we are on the direct deposit form again very very easy to fill out there are three pages to this form and they're all identical the first one is for your agency the second one is identical to the first one and that's for the financial institution meaning your bank or credit union the third one is identical to both of the previous and that is your copy just to be easy we're gonna go back to the top all you have to do is go box-to-box just like we did with every other form over here you're gonna put your name an address your telephone number and B name of person entitled to payment which is going to be you in C you go ahead and put your claim number then go to D and check off whether this is a checking or savings account then go to E and put your account number just go ahead and put your entire account number in there if there's extra boxes don't worry about it in box F you're gonna check other and write OWCP Box G you're gonna leave blank here and payee joint payee certification you're gonna go ahead and sign in date join account holder certification can be left blank in section two what you're gonna write is DOL slash OWCP in the government agency address you're gonna put the address of the local district office that services your area which can be found on any correspondence you've received from OWCP section three is gonna be filled out by your financial institution they'll put their address the routing number the depositor account title they'll go ahead and print their name sign telephone number and date it I said this is the beginning of the video you do want to make sure that everything is written clearly you go ahead and put a four and you hand write it in there but it's somewhat at OWCP interprets it as a nine your money is not going to get into your account it's gonna create a hassle for you you must write everything on every form legibly so that there's no confusion this concludes our video thank you for watching and remember to make it a great day