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September 23, 2008
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DOL Form OWCP-04
View ESA-OWCP's Form 1215-0176 Online
Agency:
ESA-OWCP
Title:
Uniform Billing Form
Form Description:
OWCP-04, Uniform Billing Form: This information is required to reimburse health care providers for services rendered to injured employees covered under OWCP-administrative programs
OMB Control Number:
1215-0176
OMB Expiration Date:
Sunday, January 31, 2010
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