Uniform Billing Form

OWCP is requesting an address change to this form. OWCP requires institutional medical providers who provide services to beneficiaries covered under FECA, BLBA, and EEOICPA to bill using a form based on the industry standard, the UB-04. Form OWCP-04 identifies the beneficiary, the type of services provided, the conditions being treated and billed amounts. This information is required by OWCP to enable it to pay providers for covered services.

The latest form for Uniform Billing Form expires 2022-03-31 and can be found here.