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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.
Title: ca-17.pdf Author: DOLMAIN Created Date: 6/26/2019 9:31:59 AM
11 lip 2023 · ⚠️ Notice: This form may be outdated.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
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.
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:
Date Form CA-17 Rev. Jan. 1997 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 the appropriate OWCP District Office in the spaces below.
