Search results
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:
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.
It is recommended that you take a Form CA-17 - Duty Status Report with you to give to your 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.
INSTRUCTIONS FOR COMPLETING DUTY STATUS REPORT (CA-17) CERTIFICATION: Medical Facility Name and Address. Send Original Report to: Employing Agency Address. Send a Copy of This Report to: OFFICE OF WORKERS' COMPENSATION PROGRAMS. BY SIGNING BLOCK 19 ON THE FRONT OF THIS FORM, THE PHYSICIAN CERTIFIES AS FOLLOWS:
Department of Labor: ca-17 - Free download as PDF File (.pdf), Text File (.txt) or read online for free. This document is a Duty Status Report form used by the U.S. Department of Labor to obtain medical information about an employee's work-related injury or illness.
In order to start receiving compensation as an injured federal worker, you are required to fill in certain key forms, with one of these being form CA-17.
Complete Ca-17.pdf online with US Legal Forms. Easily fill out PDF blank, edit, and sign them. Save or instantly send your ready documents.
