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Federal forms, ICRs, and supporting documents

OMB control number

Notice of Peace Corps Volunteer Authorization for Examination and/or Treatment

OMB 1240-0059 · DOL/OWCP.

OMB 1240-0059

OWCP administers the Federal Employees' Compensation Act (FECA). A Peace Corps Volunteer who sustains an injury or contracts an illness overseas while in Peace Corps service may be entitled to benefits under the FECA. DOL authorizes the Peace Corps to furnish medical benefits to a volunteer, who is injured during the volunteer’s period of service, for a period of 120 days following termination if the service volunteer’s injury meets requirements.

The latest form for Notice of Peace Corps Volunteer Authorization for Examination and/or Treatment expires 2028-12-31 and can be found here.

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