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Health Insurance Claim Form (OWCP-1500)
1240-0044 Health Insurance Claim Form (OWCP-1500) Highlighted Changes.pdf
Health Insurance Claim Form
Health Insurance Claim Form (OWCP-1500)
OMB: 1240-0044
OMB.report
DOL/OWCP
OMB 1240-0044
ICR 202312-1240-004
Health Insurance Claim Form (OWCP-1500)
( Supplementary Document )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0044 can be found here:
2024-06-17 - Extension without change of a currently approved collection
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