Ca-17 2026

See details

4.1 out of 5

48 votes

The Duty Status Report (CA-17) is a form from the U.S. Department of Labor's Office of Workers' Compensation Programs, designed to collect information regarding an employee's work status following an injury. It requires input from both the supervisor and the physician, detailing the employee's injury history, clinical findings, and ability to perform work tasks. The report emphasizes compliance with privacy laws and outlines the process for submitting the form to ensure timely benefits for the employee.

Here's how it works

01. Edit your ca 17 form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send ca 17 via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out ca-17 with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the CA-17 in the editor.
On Side A, enter the employee's name, date of injury, and OWCP file number if known. This section is crucial for identifying the employee and their case.
Next, provide details about the employee's occupation and how the injury occurred. Be specific about the parts of the body affected to ensure accurate reporting.
Switch to Side B for the physician's section. Here, they will confirm whether the history of injury corresponds with what was reported by the employee.
The physician should complete clinical findings, diagnosis, and any other disabling conditions. Ensure all fields are filled accurately to avoid delays.
Finally, have the physician sign and date the form before submitting it back to your agency and sending a copy to OWCP as instructed.

Start using our platform today for free to streamline your CA-17 form completion!