Who must complete the CA‑17 form?

Side A is filled out by the employee’s supervisor or employer, while Side B is completed by the treating physician. Both sections are required for an accurate duty status report.

Can I edit a downloaded CA‑17 PDF with Adobe Reader?

The fillable version works in any modern PDF viewer, but using the Formize online filler ensures all fields stay interactive and saves your work automatically.

How long does it take to process a CA‑17 submission?

Once the OWCP receives a correctly completed CA‑17, processing typically takes 5‑10 business days, depending on the volume of claims.

What common mistakes should I avoid?

Do not leave any required fields blank, avoid handwritten edits on the PDF, and ensure the physician’s signature and date are entered electronically.

Is the CA‑17 form specific to California?

Although the form is commonly used for California workers’ compensation claims, the CA‑17 is a federal OWCP form used nationwide.

Can I submit the CA‑17 electronically?

Yes. After completing the form online, you can email the saved PDF directly to the OWCP or upload it through your employer’s claim portal.

CA-17 Duty Status Report – Fillable PDF

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The CA-17, also known as the Duty Status Report, is the official document used by the U.S. Office of Workers' Compensation Programs (OWCP) to track an injured employee’s ability to work. Employers, supervisors, and treating physicians must complete this form to keep the worker’s claim up‑to‑date.

Our fillable PDF version lets you complete every required field directly in your browser—no extra software needed. The form is fully searchable, automatically saves your entries, and can be downloaded or printed for submission.

Using a fillable PDF reduces errors, speeds up processing, and ensures compliance with federal workers’ compensation regulations. Whether you’re a supervisor gathering job‑task details or a physician documenting medical findings, the CA‑17 form is essential for a smooth claim resolution.

Below you’ll find step‑by‑step instructions, tips to avoid common pitfalls, and answers to the most frequently asked questions about the CA‑17.

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常问问题

Who must complete the CA‑17 form?
Side A is filled out by the employee’s supervisor or employer, while Side B is completed by the treating physician. Both sections are required for an accurate duty status report.
Can I edit a downloaded CA‑17 PDF with Adobe Reader?
The fillable version works in any modern PDF viewer, but using the Formize online filler ensures all fields stay interactive and saves your work automatically.
How long does it take to process a CA‑17 submission?
Once the OWCP receives a correctly completed CA‑17, processing typically takes 5‑10 business days, depending on the volume of claims.
What common mistakes should I avoid?
Do not leave any required fields blank, avoid handwritten edits on the PDF, and ensure the physician’s signature and date are entered electronically.
Is the CA‑17 form specific to California?
Although the form is commonly used for California workers’ compensation claims, the CA‑17 is a federal OWCP form used nationwide.
Can I submit the CA‑17 electronically?
Yes. After completing the form online, you can email the saved PDF directly to the OWCP or upload it through your employer’s claim portal.

如何

如何通过 5 个简单步骤在线免费填写 CA-17 form：

1
Click the Fill‑out Button
On this page, click the bright “Fill out this form” button. The Formize PDF Filler app will open in a new tab.
2
Wait for the Filler to Load
The app loads the CA‑17 PDF in a secure viewer. This only takes a few seconds.
3
Enter All Required Information
Complete Side A (employer/supervisor details) and Side B (physician’s assessment). All fields are interactive; just type or select from dropdowns.
4
Save or Download Your Completed Form
When you’re done, click “Save” to store the file in your browser or “Download” to get a copy you can email or print.
5
Submit to the Appropriate Party
Send the finished CA‑17 to your employer, supervising manager, or the OWCP as instructed on the form.

关于

劳工部 (DOL) 表格

CA-17 form 是美国劳工部及其各个机构用来收集信息、管理计划以及执行与劳工相关的法律和法规的官方表格之一。劳工部是一个联邦行政部门，负责促进和保护工人的福利、确保公平的就业实践以及监督美国劳工和就业的各个方面。

以下是劳工部表格的一些示例：

就业资格验证（I-9 表）：虽然由美国公民及移民服务局 (USCIS) 管理，但 I-9 表通常与劳工部相关。雇主用它来验证在美国受雇的个人的身份和就业资格。

家庭和医疗休假法案 (FMLA) 表格：劳工部工资和工时部门负责管理 FMLA，并使用各种表格来实施和遵守本联邦法律的规定，包括医疗保健认证提供商表格和 FMLA 资格及权利与责任通知表格。

职业安全与健康管理局 (OSHA) 表格：OSHA（DOL 的一个部门）要求某些雇主使用 OSHA 表格 300、OSHA 表格 300A 和 OSHA 等表格保存工作场所伤害和疾病记录301 表格。

失业保险表格：劳工部的就业和培训管理局负责监督失业保险 (UI) 计划，州劳动力机构使用各种表格来管理和处理 UI 福利索赔。

工资和工时合规表：劳工部的工资和工时部门负责执行各种劳动法，包括《公平劳动标准法》(FLSA) 和《家庭和病假法》(FMLA)。雇主可能需要使用特定表格来遵守这些法律，例如工作时间记录、工资率和其他相关信息。

这些示例代表了劳工部表格的一些常见类别，但劳工部及其各个机构还使用许多其他表格来履行与劳工和就业相关的职责。所需的具体表格可能会有所不同，具体取决于所涉及的计划、法规或执法行动。建议访问美国劳工部官方网站（www.dol.gov）或咨询相关 DOL 机构或法律专业人士，以获取准确、最新的信息：有关与您的劳工相关需求或合规要求相关的特定 DOL 表格的日期信息。

特征

PDF 填充器

在线填写 PDF 表单的最简单方法

快速填写CA-17 form
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伟大的工具，所有平台
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完成的“CA-17 form”文件存储在由亚马逊云托管管理的安全数据库中。您可以随时从我们的系统中删除您的文件。在任何情况下，这些文件都会在 24 小时后自动删除。
与 CA-17 form 聊天
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