Secretary of Labor Hilda L. Solis
May 8, 2009
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DOL Form OWCP-04
View ESA-OWCP's Form OWCP-04 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
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