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INSTRUCTIONS FOR COMPLETING DUTY STATUS REPORT (CA-17) SUPERVISOR: Complete Side A and refer the form to the physician to complete Side B. Fill in the address of the Employing Agency and send a copy of this report to the OWCP address noted below. Enter the OWCP file number in the top right corner. PHYSICIAN:
All of the Federal Employees Program's online forms (with the exception of Forms CA-16, CA-26 and CA-27) are available to print and to manually fill and submit. Simply click on the appropriate form and print it using the [Print] button provided near the top of the form.
Form CA-17 - Duty Status Report: This form is provided for purpose of obtaining a medical duty status report for IW. It may be issued initially with Form CA-16.
Download Fillable Form Ca-17 In Pdf - The Latest Version Applicable For 2024. Fill Out The Duty Status Report Online And Print It Out For Free. Form Ca-17 Is Often Used In Work Related Injury, U.s. Department Of Labor - Office Of Workers' Compensation Programs, Injury Report Form, U.s. Department Of Labor, Workers Compensation Forms ...
INSTRUCTIONS FOR COMPLETING DUTY STATUS REPORT (CA-17) Complete Side A and refer the form to the physician to complete Side B. Fill in the address of the Employing Agency and the appropriate OWCP District Office in the spaces below. Enter the OWCP file number in the top right corner.
Form CA-17 Rev. Jan. 1997. INSTRUCTIONS FOR COMPLETING DUTY STATUS REPORT (CA-17) SUPERVISOR: Complete Side A and refer the form to the physician to complete Side B. Fill in the address of the Employing Agency and the appropriate OWCP District Office in the spaces below. Enter the OWCP file number in the top right corner. PHYSICIAN:
19 Νοε 2020 · It is recommended that you take with you a form CA-17 - Duty Status Report to give to the attending physician. This form provides your supervisor and OWCP with interim medical reports containing information as to your ability to return to any type of work.
