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DOL Home > Find It! By Form > DOL Form |
DOL Form OWCP-1168
Agency: | OWCP-DCMWC |
Title: | OWCP-1168, Black Lung Provider Enrollment Form |
Form Description: | OWCP-1168, Black Lung Provider Enrollment Form: The information collected on this form will be used to ensure accurate medical provider information for payment of medical and vocational rehabilitation bills. |
OMB Control Number: | 1240-0021 |