How to Fill Out and Submit Form CA-17: Duty Status Report

Form CA-17, the Duty Status Report, is filled out in two parts: your supervisor completes Side A describing what your federal job physically requires, and your treating physician completes Side B describing what you can medically do after your work injury. The finished form goes to your employing agency and the Office of Workers’ Compensation Programs (OWCP), where a claims examiner compares the two sides to decide whether you return to full duty, move to a light-duty assignment, or keep receiving wage-loss compensation.¹

As the injured employee, you are not filling out the form yourself. Your job is to obtain the form (usually from your supervisor, with Side A already done), carry it to your medical appointment, and make sure the completed document gets back to your agency quickly. The form’s instructions ask the physician to finish Side B, sign it, and return it to your employing agency within two days so your income is not interrupted.¹

Who Fills Out Which Side

The supervisor completes Side A first, then hands the entire form to the physician so the doctor can see exactly what the position requires before writing any restrictions. The physician then completes Side B and returns the form.¹ The order matters. A doctor who has not seen the job description cannot meaningfully clear you for it.

Completing Side A: The Supervisor’s Section

Side A opens with basic identifying information: your name, date of birth, OWCP case file number, occupation, and date of injury. The substance of the section is Item 7, a grid of twenty physical activities and environmental exposures. For each one, the supervisor checks whether the task is performed continuously or intermittently and records how many hours per day you spend on it.¹

The activities and exposures listed on the form are:

Lifting and carrying, with the maximum weight in pounds
Sitting, standing, and walking, in hours per day, continuous or intermittent
Climbing, kneeling, bending or stooping, twisting, pulling, and pushing, in the same format
Simple grasping and fine manipulation, with keyboarding counted under fine manipulation
Reaching above the shoulder, in hours per day
Driving a vehicle, with the type specified
Operating machinery, with the type specified
Temperature extremes, with the range in degrees Fahrenheit
High humidity, chemicals and solvents, fumes and dust, and noise, with specific substances identified and a decibel level for noise
An “other” line for any additional demands

Accuracy on Side A is not a formality. If lifting requirements are understated or a chemical exposure is left off, the physician may clear you for tasks your body cannot safely handle. If demands are overstated, you can end up sidelined longer than necessary. The form does not define “continuous” versus “intermittent”; a sustained task running through the workday is continuous, while a task that happens in shorter stretches with breaks between them is intermittent.

Completing Side B: The Physician’s Section

Side B is where clinical findings become concrete work restrictions. The physician looks at the demands the supervisor listed on Side A and then fills in several fields.¹

Item 9 asks for clinical findings from the most recent examination. These are objective medical observations, not just reported symptoms. Item 13 is the decisive question: can the employee perform the regular work described on Side A? If yes, the physician indicates full-time or part-time and specifies hours per day. If no, the physician completes a restriction grid that mirrors the Side A activity categories, marking what you can do and for how long.

The physician can also record environmental restrictions. A doctor might note, for example, that you should avoid temperatures below 40°F or above 85°F, stay away from specific solvents, or not operate heavy machinery because of medication side effects. Environmental limits are easy to overlook and often decide whether a return-to-work attempt succeeds.

Item 19 is the signature and date. That signature certifies that the responses are true, complete, and correct, and the form warns that knowingly false or misleading statements can lead to criminal prosecution.¹

Where to Get the Form and How to Submit It

A blank CA-17 is available on the Department of Labor’s OWCP forms page and through the Employees’ Compensation Operations and Management Portal (ECOMP).² Often your supervisor will hand you a copy with Side A already filled out before your next appointment.

ECOMP is the preferred way to submit. You register for an account, upload the completed form, and tie the submission to your FECA case number. A confirmation typically appears in your case file within a few business days.³ If you do not have digital access, your employing agency can submit the form for you, or you can mail a paper copy to the OWCP district office handling your claim. Your claims examiner or agency workers’ compensation coordinator has the correct mailing address.

The two-day turnaround built into the instructions matters. Do not let the form sit in a drawer after your visit. Get it back to your supervisor, or upload it to ECOMP, promptly.¹

How Often You Will Submit a New One

The CA-17 is not a one-time filing. Your employer is entitled to monitor your medical progress and duty status through periodic medical reports, and the CA-17 is the standard tool for that.⁴ The regulation does not set a fixed schedule. Your claims examiner or agency typically requests updated reports at intervals that match your condition, often every 30, 60, or 90 days, or after a significant event like surgery or a change in treatment.

Your employer may also write to your physician to ask about work limitations and possible assignments, but cannot contact your doctor by phone or in person. Any written correspondence must be copied to both you and OWCP, along with the physician’s response.⁴

What Happens After You Submit

Once the completed form reaches your agency and OWCP, the claims examiner compares the physician’s restrictions on Side B against the demands your supervisor recorded on Side A. Three outcomes are possible. If the physician clears you for full duty, wage-loss compensation stops and you return to your regular position. If the physician allows partial duty, the agency should offer a light-duty or modified assignment that fits within the restrictions. If the physician says you cannot work at all, your disability compensation continues.

What Goes Wrong If You Don’t Cooperate

The stakes on the CA-17 are real. When your physician documents on Side B that you can perform certain tasks, and your agency offers a job that falls within those restrictions, that job is treated as suitable work. Refusing to seek suitable work, or refusing to do it once offered, ends your entitlement to wage-loss compensation.⁵ OWCP follows a two-notice process before terminating benefits, and you can accept the job or explain why you cannot do it. The burden is on you to show the refusal was reasonable.⁶

Even if compensation is terminated for refusing suitable work, you remain entitled to medical benefits for your accepted condition.⁶ Losing wage-loss payments is still a serious financial hit.

The form’s fraud warning is directed at the physician, but the same exposure reaches supervisors who misrepresent job demands on Side A and employees who pressure a doctor to exaggerate restrictions. False or misleading statements, or concealment of material facts, can lead to criminal prosecution under federal workers’ compensation fraud statutes.¹

Don’t Confuse the CA-17 With the CA-20

If you are filling out paperwork right after your injury, the CA-17 may not be the form you need yet. The CA-20, Attending Physician’s Report, captures the initial diagnosis, treatment plan, and early restrictions when a claim is first established. The CA-17 is the periodic check-in that tracks how your restrictions change over time and whether you can handle the specific duties of your position. The CA-20 is the opening snapshot; the CA-17 is the ongoing progress report.

1
Office of Workers’ Compensation Programs. Duty Status Report – CA-17
2
U.S. Department of Labor. Forms
3
U.S. Department of Labor ECOMP. Employees’ Compensation Operations and Management Portal
4
eCFR. 20 CFR 10.506 – May the Employer Monitor the Employees Medical Care
5
Office of the Law Revision Counsel. 5 USC 8106 – Partial Disability
6
eCFR. 20 CFR 10.517 – What Are the Penalties for Refusing to Accept a Suitable Job Offer