Information Collection Request
Uniform Billing Form
ICR 202501-1240-003 · OMB 1240-0019 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form OWCP-04 Uniform Billing Form (OWCP-04) |
Form and Instruction | Modified | Repair queued |
 ICR 1240-0019 - Supporting Statement_20250328.docx |
Supporting Statement A | Uploaded 2025-03-28 | Repair queued |
 20 CFR 725.405, 406, 701 and 705 BLBA Supporting Reg.pdf |
Supplementary Document | Uploaded 2012-11-05 | Repair queued |
| 20 CFR 30.701 EEOICPA Supporting Reg.pdf |
Supplementary Document | Uploaded 2012-11-05 | Repair queued |
| 20 CFR 10.801 FECA - Supporting Reg.pdf |
Supplementary Document | Uploaded 2012-11-05 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 38466 |  Uniform Billing Form (OWCP-04) |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/OWCP |
| OMB Control No | 1240-0019 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202312-1240-005 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |