Claim for Medical Reimbursement Form

Form OWCP-915 is used to claim reimbursement for out-of-pocket covered medical expenses paid by a beneficiary, and must be accompanied by required billing data elements (prepared by the medical provider) and by proof of payment by the beneficiary.

The latest form for Claim for Medical Reimbursement Form expires 2027-07-31 and is listed under ICR 202601-1240-001.