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:

Submit forms online through the Employees' Compensation Operations and Management Portal (ECOMP). On the ECOMP site you can register for an account, initiate a claim, upload documents, submit forms, and access your case. OWCP's Federal Employees Program has made a variety of forms available online. These forms are only available in PDF format.

Title: ca-17.pdf Author: DOLMAIN Created Date: 6/26/2019 9:31:59 AM

CA17 - Duty Status Report . CA20 - Attending Physicians Report . CA35 - Evidence Required in Support of Claim for Occupational Disease . OWCP 5a - Work Capacity Evaluation . OWCP 5b - Work Capacity Evaluation . OWCP 5c - Work Capacity Evaluation . OWCP 915 - Claim for Medical Reimbursement .

Form CA-17 For common positions in EA, have a pre-prepared CA-17 with the left side completed for the injured worker to provide to their physician. On Form CA-17, the EA should indicate light duty work is available.

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

employee sustained a traumatic injury and is disabled for work, reports on Form CA 17, “Duty Status Report” may be required by the employing agency during the first 45 days of disability. If

2019年9月12日 · 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.

Form CA-17 is designed to be filled out by the injured worker’s supervisor and his/her treating physician to complete. It is split into two sections: A and B. Side A is to be completed by the employee’s supervisor.