OMB
.report
Search
Health Insurance Claim Form
Health Insurance Claim Form
OMB: 1240-0044
IC ID: 43805
OMB.report
DOL/OWCP
OMB 1240-0044
ICR 202404-1240-009
IC 43805
( )
Documents and Forms
Document Name
Document Type
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
Information Collection (IC) Details
© 2024 OMB.report |
Privacy Policy