Information Collection Request
Claim for Medical Reimbursement Form
ICR 202404-1240-007 · OMB 1240-0007 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0007 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form OWCP-915 Claim for Medical Reimbursement Form |
Form and Instruction | Modified | Repair queued |
 1240-0007 Supporting Statement_2024__05232024_MN clean.docx |
Supporting Statement A | Uploaded 2024-05-23 | Repair queued |
 Energy Employees Occupational Illness Compensation Program Act (EEOICPA).pdf |
Supplementary Document | Uploaded 2021-04-22 | Repair queued |
| Black Lung Benefits Act.pdf |
Supplementary Document | Uploaded 2021-04-22 | Repair queued |
| Employees Compensation Act.pdf |
Supplementary Document | Uploaded 2021-04-22 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 38473 |  Claim for Medical Reimbursement Form |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/OWCP |
| OMB Control No | 1240-0007 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202102-1240-004 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |