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  • U.s. Department Of Labor Duty Status Report - Blm

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Or the employee named below. This request OMB No. 1215-0103 Expires: 08-31-05 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 seq.) and is OWCP File Number required to obtain or retain a benefit. Information collected will be handled and stored in compliance with the Freedom (If known) of Information Act, the Privacy.

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CA-17 - Duty Status Report. This form allows the physician to keep your supervisor updated on your work restrictions and/or duty status.

Instructions for Completing Form CA-7A Time Analysis. General: This form is used when claiming FECA compensation, including repurchase of paid leave. It must be used when claiming compensation for more than one consecutive period of leave.

These forms are used for filing claims for wage loss or permanent impairment due to a Federal employment-related injury, and to obtain necessary medical documentation to determine whether a claimant is entitled to benefits under the Federal Employees Compensation Act (FECA), 5 U.S.C. 8101 et.

The CA-17 was designed to provide the doctor with an accurate description of the physical work requirements of the injured letter carrier. The CA-17 is a legal document that determines both an injured worker's medical restrictions and entitlement to wage-loss compensation benefits.

This form guarantees payment to the care provider if the employee requires medical treatment because of a work- related traumatic injury. â–ª CA-20 Attending. Physician's Report. A medical report is required by OWCP BEFORE payment of compensation for loss of wages can be made to the employee.

There are two sides to the CA-17: Side A is completed by the employee's supervisor and Side B is completed by the employee's physician. A properly completed CA-17 should give the doctor an accurate picture of a worker's daily work duties so that accurate work restrictions can be noted.

Form CA-7 is used by federal workers seeking to claim compensation for traumatic injuries suffered while on the job, as well as those who may have sustained an occupational disease during the performance of work-related duties.

0:46 22:22 How to Fill In The CA 7, 7a, 7b - YouTube YouTube Start of suggested clip End of suggested clip File number or claim number and the date of injury are gonna be on your approval letter from OWCP.MoreFile number or claim number and the date of injury are gonna be on your approval letter from OWCP. So if you do forget it go ahead and get it from there. Your social is necessary.

When an injured worker has permanent loss of use of certain body parts or organs, s/he may request a schedule award by submitting a CA-7 Claim for Schedule Award and an impairment rating completed by her/his treating physician.

It is recommended that you take with you a form CA-17 - Duty Status Report to give to the attending 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.

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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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