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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 sie 2014 · Easily create and download a Duty Status Report (Form CA-17) in PDF or Word format at Templateroller.com. Fill out online or download blank form for free.
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.
3 lip 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.” Download [148.26 KB]
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.
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.
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.
