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Get DoL CA-17 1997

His 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 Act of 1974 and the OMB Cir. A-108. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. SIDE A - Supervisor: Complete this side and refer to physician SIDE B - Physicia.

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