Transcription of CA-17 - Duty Status Report - npmhul310.org
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CA-17 - Duty Status Report - npmhul310.org
HBK EL-505, INJURY COMPENSATION, DECEMBER 1995 FORMS447 OWCP Form CA-17 InstructionsSummaryPurposeTo keep the ICCO and the OWCP office informed of the injured or ill employee sability to return to either limited or full By1. SIDE For initial disability: direct For continuing full or partial disability: ICCO2. SIDE B: Treating PhysicianWhen to Prepare1. After initial injury to accompany the For continuing total disability for each medical visit; or at a minimum of eachtwo For continuing limited duty or follow up examinations when employee hasreturned to Procedures1. The appropriate official completes Side A2. The employee delivers this form, along with the CA-16, job descriptions, andOWCP Form 1500 as appropriate, to the treating The treating physician will complete Side B of the form and either give it,along with the approved job descriptions, to the employee for immediatereturn to the ICCO or, if necessary, mail to the ICCO in the and DistributionFiling and distribution procedures are as follows:1.
HBK EL-505, INJURY COMPENSATION, DECEMBER 1995 FORMS 447 OWCP Form CA-17 Instructions Summary Purpose To keep the ICCO and the OWCP office informed of the injured or ill employee’s
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