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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:
1 Αυγ 2014 · 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.
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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. Supervisor/Employing Agency completes agency portion by describing physical requirements of IW's job and noting availability of light or limited duty.
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. SUPERVISOR:
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