Secretary of Labor Hilda L. Solis
May 8, 2009
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DOL Form OWCP-1500
View ESA-OWCP's Form OWCP-1500 Online
Agency:
ESA-OWCP
Title:
OWCP-1500, Health Insurance Claim Form
Form Description:
OWCP-1500, Health Insurance Claim Form: This information is required to reimburse health care providers for services rendered to injured employees covered under OWCP-administrative programs.
OMB Control Number:
1215-0055
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