Rehabilitation Maintenance Certificate

OMB 1240-0012

Form OWCP-17 serves as a bill submitted by the program participant or OWCP, requesting reimbursement of expenses incurred due to participation in an approved rehabilitation effort for the preceding four-week period of fraction thereof.

The latest form for Rehabilitation Maintenance Certificate expires 2022-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form OWCP-17 Rehabilitation Maintenance Certificate Form
Occupational Employment and Wages for Rehabilitation Counselors BLS May 2020.docx Supplementary Document
Supporting Statement for 1240-0012 final.docx Supporting Statement A
Office of Workers' Compensation Programs Longshore and Harbor Workers' Compensation Act Case Files.docx Supplementary Document
Office of Workers' Compensation Programs, Longshore and Harbor Worker's Compensation Act Special Fund System.docx Supplementary Document
Privacy Act Systems-FECA.docx Supplementary Document
General Schedule.html Supplementary Document
Rehabilitation Maintenance Certificate Form

All Historical Document Collections

202110-1240-001 Approved with change	Extension without change of a currently approved collection	2022-01-14
202008-1240-063	No material or nonsubstantive change to a currently approved collection	2020-12-15
201805-1240-007 Approved without change	Revision of a currently approved collection	2018-11-30
201503-1240-001 Approved with change	Revision of a currently approved collection	2015-07-23
201112-1240-001 Approved without change	Revision of a currently approved collection	2012-06-28
201003-1240-012 Approved without change	Extension without change of a currently approved collection	2010-03-12