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OWCP-1168 Web vers Provider Enrollment For, Screen Shots
Provider Enrollment Form
Screen Shots of Billing Contractor's Web Portal
Provider Enrollment Form
OMB: 1240-0021
OMB.report
DOL/OWCP
OMB 1240-0021
ICR 201712-1240-002
IC 38462
OWCP-1168 Web vers Provider Enrollment For, Screen Shots
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0021 can be found here:
2023-10-03 - Revision of a currently approved collection
2023-01-20 - No material or nonsubstantive change to a currently approved collection
Document [pdf]
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pdf
Billing Contractor’s Web Portal Billing Contractor’s Web Portal (Continued)
File Type
application/pdf
Author
Ferguson, Yoon - OWCP
File Modified
2015-09-15
File Created
2015-09-15
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