An interested party or authorized representative may file a Petition for Rearrangement or Readjustment of Compensation if a qualifying change in earning capacity or condition has occurred since the last loss of earning capacity determination was made.  The burden of proof to establish the change rests with the filing party.  This form may be used to file a Petition for Rearrangement or Readjustment of Compensation.  It must be completed in its entirety.  Failure to do so may cause a delay in processing.

This form must be submitted by the 5th Business Day from the cleared date of the ACH Payment. Once completed, email the form to the GAO AFIS Operations Group at: [email protected].