Printing - FECA-PT2 - National Association of Letter Carriers

2-0806 Exhibit 19: Sample Letter to Agency--Skin Condition
Dear EMPLOYING AGENCY REPRESENTATIVE:
I am writing in reference to the claim for benefits under the Federal Employees' Compensation Act (FECA)
filed by the above-named employee for a skin condition. We have reviewed the Form CA-2 and all
accompanying information. We need the following additional information from you to determine whether
the employee is eligible for benefits under the FECA.
1. Provide comments from a knowledgeable supervisor on the accuracy of all statements given by the
employee relative to this claim. Does the agency concur with the employee's allegations? If there are
points of disagreement, please explain fully and provide any supporting evidence.
2. To what potentially harmful substances has the employee been exposed? Include any fumes,
solvents, chemicals, etc. Provide the trade name, generic name, manufacturer and ingredients. Provide a
copy of the safety data sheet furnished by the supplier if applicable.
3. What tasks did the employee perform which resulted in the exposure or contact? What was the
frequency and duration of exposure?
4. What precautions were taken to minimize effects of exposure (e.g., gloves, a mask)?
5. Provide a copy of this employee's position description and physical requirements of the job. If the
actual duties varied from the official description, explain how.
6. [FREE FLOW IF DESIRED]
Title 20 CFR 10.102(b) provides that, in the absence of a full reply from the agency, we may accept the
claimant's allegations as factual. Your assistance in ensuring that all requested information is provided to
OWCP within 30 days is appreciated.
If clarification of any portion of this request is required, or if you cannot provide any requested
information, please contact us immediately. Thank you for your assistance.
Sincerely,
NAME OF SIGNER
TITLE
FECA-PT2 Printed: 06/08/2010 270