OMB control number

Representative Fee Request

OMB 1240-0049 · DOL/OWCP.

OMB 1240-0049

Individuals filing for compensation benefits with OWCP may be represented by an attorney or other representative. The representative is entitled to request a fee for services under the Federal Employees' Compensation Act (FECA). The fee must be approved by the OWCP before any demand for payment can be made by the representative. This information collection request sets forth the criteria for the information, which must be presented by the respondent in order to have the fee approved by OWCP. The information collection does not have a particular form or format; the respondent must present the information in any format which is convenient and which meets all of the required criteria.

The latest form for Representative Fee Request expires 2028-06-30 and can be found here.

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