OMB control number
Claim for Medical Reimbursement Form
OMB 1240-0007 · DOL/OWCP.
OMB 1240-0007
Form OWCP-915 is used to claim reimbursement for out-of-pocket covered medical expenses paid by a beneficiary, and must be accompanied by required billing data elements (prepared by the medical provider) and by proof of payment by the beneficiary.
The latest form for Claim for Medical Reimbursement Form expires 2027-07-31 and can be found here.
Latest Forms, Documents, and Supporting Material
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Form and Instruction |
Justification for No Material/Nonsubstantive Change |
Supplementary Document |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Form OWCP-915 Claim for Medical Reimbursement Form
Justification for 1240-0007 Claim for Medical Reimbursement (OWCP-915).docx
Energy Employees Occupational Illness Compensation Program Act (EEOICPA).pdf
Claim for Medical Reimbursement Form All Historical Document Collections