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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:
Title: ca-17.pdf Author: DOLMAIN Created Date: 6/26/2019 9:31:59 AM
The CA-17 is a legal document that determines both an injured worker’s medical restrictions and entitlement to wage-loss compensation benefits. When completed, the CA-17 contains sensitive medical information and is protected under the Privacy Act. There are two sides to the CA-17: Side A is completed
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12 wrz 2019 · To help injured employees return to suitable employment, the Postal Service may request medical progress reports. Form CA-17 is generally used for this purpose but is not required. Preexisting disabilities, workrelated or otherwise, are factored into job offers and therefore should be included.
11 lip 2023 · ⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0046 can be found here: 2024-08-20 - No material or nonsubstantive change to a currently approved collection; 2023-07-11 - Revision of a currently approved collection
This form is provided for the purpose of obtaining a duty status report for the employee named below. This request does not constitute authorization for payment of medical expense by the Department of Labor, nor does it invalidate any previous authorization issued in this case. This request for information is authorized by law (5 USC 8101 et ...
