Information Collection

OWCP Medical Bill Processing Questionnaire

IC 263803 under ICR 202503-1225-001 · OMB 1225-0093.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0093 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OWCP Medical Bill Processing Questionnaire	Form and Instruction
OWCP Medical Bill Processing Questionnaire OWCP Medical Bill Processing Questionnaire	Form and Instruction
OWCP Medical Bill Processing Questionnaire OWCP Medical Bill Processing Questionnaire_12.5.2023_Clean Copy.docx forms.office.com/r/QETPjc43mu	Form and Instruction
OWCP Medical Bill Processing Questionnaire OWCP Medical Bill Processing Questionnaire_12.5.2023_Clean Copy.docx forms.office.com/r/QETPjc43mu	Form and Instruction
ICR Template_A11 Section 280 Clearance - OWCP MBP Questionnaire_12.5.2023.docx A-11 Section 280 Coversheet	IC Document
ICR Template_A11 Section 280 Clearance - OWCP MBP Questionnaire_12.5.2023.docx A-11 Section 280 Coversheet	IC Document

IC Title:

OWCP Medical Bill Processing Questionnaire

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A			https://forms.office.com/r/QETPjc43mu	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
A-11 Section 280 Coversheet		12/05/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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