OMB control number
Rehabilitation Maintenance Certificate
OMB 1240-0012 ยท DOL/OWCP.
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 or fraction thereof.
The latest form for Rehabilitation Maintenance Certificate expires 2028-04-30 and is listed under ICR 202502-1240-004.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form OWCP-17 Rehabilitation Maintenance Certificate | Form |
 Form OWCP-17 Rehabilitation Maintenance Certificate | Form |
| PC_202502-1240-004_042125_104431_1.pdf | Public Comments |
| PC_202502-1240-004_042025_105923_1.pdf (document unavailable) | Public Comments |
 1240-0012 Supporting Statement 2025.docx | Supporting Statement A |
| 1240-0012 Supporting Statement 2025.docx | Supporting Statement A |
| Rehabilitation Counselors Wages.pdf | Supplementary Document |
| Office of Workers' Compensation Programs Longshore and Harbor Workers' Compensation Act Case Files.docx | Supplementary Document |
| Privacy Act Systems-FECA.docx | Supplementary Document |
| Office of Workers' Compensation Programs, Longshore and Harbor Worker's Compensation Act Special Fund System.docx | Supplementary Document |
 Rehabilitation Maintenance Certificate |
Form |
| Rehabilitation Maintenance Certificate |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202502-1240-004 | Revision of a currently approved collection | 2025-03-21 | ||
| 202110-1240-001 | Extension without change of a currently approved collection | 2022-01-14 | Approved with change | |
| 202008-1240-063 | No material or nonsubstantive change to a currently approved collection | 2020-12-15 | ||
| 201805-1240-007 | Revision of a currently approved collection | 2018-11-30 | Approved without change | |
| 201503-1240-001 | Revision of a currently approved collection | 2015-07-23 | Approved with change | |
| 201112-1240-001 | Revision of a currently approved collection | 2012-06-28 | Approved without change | |
| 201003-1240-012 | Extension without change of a currently approved collection | 2010-03-12 | Approved without change |