Uniform Billing Form

OWCP requires institutional medical providers who provide services to beneficiaries covered under the Federal Employees’ Compensation Act (FECA), 5 U.S.C. 8101, the Black Lung Benefits Act (BLBA), 30 U.S.C. 901, and the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 U.S.C. 7384, to bill using a form based on the industry standard form approved by the American Hospital Association, the UB-04. Form OWCP-04 identifies the beneficiary, the type of services provided, the conditions being treated and billed amounts. This information is required by OWCP to enable it to pay providers for covered services.

The latest form for Uniform Billing Form expires 2028-05-31 and can be found here.