Printing - FECA-PT2 - National Association of Letter Carriers

Memorandum of Agreement – Housing Modification
(Office of Workers’ Compensation Programs and Property Owner)
This agreement establishes the parameters under which the Office of Workers’ Compensation Programs
(OWCP) agrees to pay for the modification of CLAIMANT’s primary residence at ADDRESS, owned by
(OWNER INFORMATION).
It is understood that CLAIMANT does not own the property at stated address, but that he or she is living
with you and that you have agreed to provide housing to him or her on an ongoing and continuous basis.
It is also understood that the modifications in question are needed due to the limitations caused by
CLAIMANT’s accepted work injury.
The undersigned agree to the following:
1. You agree to the renovations described below. OWCP will pay for these modifications, and only
these modifications, as described in the attached document from CONTRACTOR NAME.
List all approved modifications here. If necessary, list subcategories such as
general construction, plumbing work, etc. The items listed here should be the
same as those provided on the claimant agreement.
2. You will notify OWCP before any move which may result in a claim for a new house or a claim for
modifications on a new house.
3. You agree that you will provide proof of adequate insurance, including home owner’s insurance that
reflects the value of your house, upon completion of the approved renovations. You will send proof
of insurance to OWCP once renovations have been completed.
4. You must notify OWCP if you intend to relinquish your ownership of the house.
5. You understand that the Government is entitled to reimbursement for the value of the home
modifications described in this agreement if the property is relinquished or the modifications are no
longer needed if the value at that time exceeds $10,000. If the value is greater than $10,000
when relinquished or no longer needed, the amount of value above $10,000 must be reimbursed to
the Department of Labor in a percentage of the total value based on the period of use. The
Government agrees that the value of the home modifications will decrease at the rate of 10
percent of the total per year. For example: If the home modifications are completed in December
of 2009 and CLAIMANT resides in the house until December of 2015, the value of the renovations
would have decreased by 60% in that time. The Government at that time would be entitled to
reimbursement for 40% of the amount paid for the modifications. If CLAIMANT lives in the home
and requires the modifications for 10 years, the Government is no longer entitled to any
reimbursement amount. The government will not seek reimbursement of any amount until
FECA-PT2 Printed: 06/08/2010 735