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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.
The CA-17 is a form that describes the work duties and restrictions of a letter carrier who reports an on-the-job injury. Learn how to fill out and review the CA-17 correctly to ensure accurate medical treatment and wage-loss benefits.
Pre–Tax Health Insurance Premium Waiver/Restoration Form for Career Employees . 524.832. PS 8202 . Pre–Tax Health Insurance Premium Election/Waiver Form for Noncareer Employees . 524.833. PS 8214 . Certificate of OSHA, Safety, and Environmental Records Transfer. 811.42. RI 76–10. Assignment of Federal Employees’ Group Life Insurance ...
3 Ιουλ 2017 · While many doctors have their own forms for describing work restrictions, compensably injured workers should provide their doctors with a properly filled out OWCP Form CA-17, Duty Status Report.”
Form CA-17 For common positions in EA, have a pre-prepared CA-17 with the left side completed for the injured worker to provide to their physician. On Form CA-17, the EA should indicate light duty work is available.
This form is used to obtain or retain a benefit for an employee who has a work-related injury or illness. It requires information from the supervisor, the physician, and the employee, and must be returned to the employing agency and the OWCP office within 2 days.
