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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 .

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CA-17 - GACC-NIFC
U.S. Department of Labor. Office of Workers' Compensation Programs. Duty Status Report...
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Website: https://www.ecomp.dol.gov/# Ensure that TSL1.1 or 1.2 security ... CA-17, Duty...
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CA810 Revised 2009 CA 801 810 - UserManual.wiki
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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 is designed to be filled out by the injured worker's supervisor and his/her treating physician to complete. ... Side A is to be completed by the employee's supervisor.

Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider if the employee requires medical treatment because of a work-related traumatic injury. Your supervisor should complete page 1 of Form CA-16 and provide it to you for your attending physicians information.

CA-20 Form, Attending Physician's Report - This medical report is required by OWCP BEFORE payment of compensation for loss of wages can be made to the employee. Recommend this form used in lieu of a narrative medical report issued by the physician.

With both forms, there is also a three-year limit for claiming compensation. With the CA-1 form, the deadline is three years from when you suffered the injury. With the CA-2 form, the deadline is three years from when you first became aware of the medical condition.

The CA-17 is a form which the OWCP directs both the injured worker's supervisor and his/her treating physician to complete. It is split into two sections. Side A is completed by the employee's supervisor.

A claim for COP must be submitted no later than 30 days following the injury (the form CA-1 is designed to serve as a claim for continuation of pay). If disabled and claiming COP, submit to your employing agency within 10 work days medical evidence that you sustained a disabling traumatic injury.

CA-2 - Notice of Occupational Disease and Claim for Compensation. ... CA-7 - Claim for Compensation on Account of Traumatic Injury or Occupational Disease. Used for the following purposes: To claim lost wages when continuation of pay expires on a traumatic injury, and to claim wage loss on occupational disease claims.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232