Ca 17 Printable Form – This form is provided for purpose of obtaining a medical duty status report for iw. Claimants must establish the five basic elements for adjudication as set forth under the federal employees’ compensation act (feca) as follows: 1) the claim was timely filed; Simply click on the appropriate form and print it using the [print] button provided near the top of the form.
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Ca 17 Printable Form
Fill in the address of the employing agency and the appropriate owcp district office in the spaces below. Department of labor, united states federal legal forms, legal and. Fill out the duty status report online and print it out for free.
Supervisor/Employing Agency Completes Agency Portion By Describing Physical Requirements Of Iw's Job And Noting Availability Of Light Or Limited Duty.
Enter the owcp file number in the top right corner. 2) the claimant is a civil employee of the federal government; Hit the green arrow with the inscription next to.
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