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View ESA-OWCP-DFEC's Form 1215-0103 Online 
| Agency: |
ESA-OWCP-DFEC |
| Title: |
DFEC CA-20, Attending Physician's Report |
| Form Description: |
DFEC CA-20, Attending Physician's Report: This medical report is required before payment of compensation for loss of wages or permanent disability can be made to the injured employee. This information is required to obtain or retain a benefit. |
| OMB Control Number: |
1215-0103 |
| OMB Expiration Date: |
Friday, September 30, 2011
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