Please rate Owcp 915 Rev. 12-25
Form OWCP-915 can be used to seek reimbursement for expenses in regard to medical treatment, prescription medication and medical supplies.
Each provider: a separate OWCP-915 must be filed for each provider.
Prescription medication: a paper pharmacy billing form, which must be attached to the OWCP-915, and proof of payment.
Other medical expense: the OWCP-1500 or OWCP-04 must be attached to this form.
Payment: to receive payment, you must have electronic banking information (Electronic Funds Transfer or EFT) on file with the appropriate program.
| Question | Answer |
|---|---|
| Form Name | Form OWCP-915 |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 65 |
| Avg. time to fill out | 11 min |
| Edition | 12-25 |
| Issuing agency | U.S Department of Labor Office of Workers' Compensation Programs |
| Where to send | The appropriate program address |
| Other names | OWCP-915, OWCP915, OWCP 915, Form OWCP-915, Claim for Medical Reimbursement, OWCP medical reimbursement form |
| Official source | Form OWCP-915 (Rev 12-25), U.S Department of Labor Office of Workers' Compensation Programs |
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Please rate Owcp 915 Rev. 12-25
