This form is used by an employee to claim compensation in an established case for traumatic injury or occupational disease. As the supervisor, you will receive an email from ECOMP notifying you that a form requires your review.  In this email, a link will be provided to access the form directly. You will then be directed to provide some information regarding the employee such as their pay, schedule, health benefits code, life insurance code and Continuation of Pay dates (if applicable ). Once you provide information about the employee the form will then require you to enter your name, job title and contact information in the event the Department of Labor have questions.

Please note that the Agency has 5 business days to submit a claim for compensation. If you have questions, please contact the NIH Workers’ Compensation Program at 301-402-2669.