Health Insurance Claim Form

Health Insurance Claim Form

OMB: 1240-0044

IC ID: 43805

Documents and Forms

Document Name Document Type
Form OWCP-1500 Health Insurance Claim Form Form and Instruction
Form OWCP-1500 Health Insurance Claim Form Form and Instruction
OWCP-1500 Health Insurance Claim Form 1240-0044 Health Insurance Claim Form (OWCP-1500).pdf www.dol.gov/owcp/dfec/regs/compliance/OWCP-1500.pdf Form and Instruction