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17. Agency name and address of reporting office (Include city, state, and zip c ode) OWCP Agency Code OSHA Site Code Zip Code 18. Employee's duty station (Street address and zip code) Zip Code 19. Regular work hours a.m. p.m. a.m. From: p.m. To: 20. Regular schedule Sun Mon. Tues. Wed. Thurs. Fri. Sat. 21. Date of Injury Mo. Day Yr. 22. Date ...
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