Form ca-17 duty status report
WebForm CA-16 will not be issued to more than one provider or 7 days after injury. o Provide your doctor’s name, address and phone number to your supervisor and the ... • Ensure Form CA-17, Duty Status Report, is completed by your treating physician at the initial and subsequent visits. WebCA–3 . Report of Termination of Disability and/or Payment . 525.148. CA–5. Claim for Compensation by Widow, Widower, and/or Children ... CA–17. Duty Status Report. 544.12, 545.52. CA–20. Attending Physician’s Report. 525.141, 545.5. ... Pre–Tax Health Insurance Premium Election/Waiver Form for Noncareer Employees . 524.833. PS 8214 ...
Form ca-17 duty status report
Did you know?
WebForm CA-17 Rev. Jan. 1997 e. Climbing (Specify) range in degrees F OMB No. 1240-0046 Expires: 09-30-2011 OWCP File Number (If known) 8. Does the History of Injury Given to … WebThe agency should also supply the employee with a Form CA-17 (Duty Status Report) for completion by the physician providing medical care. e. Controversion. The agency will inform the employee whether COP will be controverted and, if so, whether pay will be terminated, and the basis for such action. The reasons must conform to those indicated in ...
WebThe CA-17, Duty Status Report is provided by the supervisor to the injured employee and attending physician to indicate the availability of light-duty. It also serves as an interim … http://www.owcp.com/retainer-2/
WebJul 3, 2024 · Use Fill to complete blank online AFGE LOCAL 1040 MEMBERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable. Ca-17 DOL-ESA Forms. On average this form takes 30 minutes to complete. The Ca-17 DOL-ESA Forms form is 2 pages long and contains: 0 … WebINSTRUCTIONS 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 …
Webform ca17 ca17 usps regs dol gov compliance If you believe that this page should be taken down, please follow our DMCA take down process here. Ensure the security of your data …
WebTitle: ca-17.pdf Author: DOLMAIN Created Date: 6/26/2024 9:31:59 AM railroad worker phineas gageWebForm CA-17 Duty Status Report. This is one of the first OWCP documents your doctor will be asked to complete. The left side, Side A, is completed by your supervisor, who should enter your usual work requirements as requested by Section 7 on that form. railroad workers current contractWebINSTRUCTIONS 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 … railroad workers new contractWebCA17 - Duty Status Report . CA20 - Attending Physicians Report . ... OWCP 957 - Medical Travel Refund Request . CA-1122 - Short Form 3rd Party Recovery . CA-1108 - Long Form Recovery for 3rd Party Injuries . FECA sf1199a - Direct Deposit Form . PS Form 3971 - (USPS Only) Injured Federal Worker? Watch this video. Get a Free Consultation. railroad workers sick timeWebIt is recommended that you take a Form CA-17 - Duty Status Report with you to give to your physician. This form provides your supervisor and OWCP with interim medical … railroad workers paid vacation daysWebFeb 24, 2024 · ca-17 FECA Medical Report Forms, Claim for Compensation OMB: 1240-0046 OMB.report DOL/OWCP OMB 1240-0046 ICR 201003-1240-046 IC 13770 CA-17 Duty Status Report ( ) ⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0046 can be found here: railroad workers salaryWebINSTRUCTIONS 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. Enter the OWCP file number in the top right corner. PHYSICIAN: railroad workers sick day