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November 4, 2008    DOL Home > Find It! By Form > DOL Form   

DOL Form OWCP-04

View ESA-OWCP's Form 1215-0176 Online htm
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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