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The document is a Provider Enrollment Form issued by the U.S. Department of Labor for medical providers seeking to enroll or update their information in the Office of Workers’ Compensation Programs. It includes sections for personal and practice information, provider type, licensing details, and billing preferences. The form also outlines the privacy and public burden statements related to the collection of information.

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Versions	Form popularity	Fillable & printable
2023	4.9 Satisfied (22 Votes)
2020	4.8 Satisfied (90 Votes)
2015	4.4 Satisfied (63 Votes)
2009	4.4 Satisfied (64 Votes)
2004	4.3 Satisfied (46 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I contact the US Department of Labor?

For answers to general questions about employment laws, workplace issues, or other labor topics, please call our National Contact Center at 1-866-4-USA-DOL (1-866-487-2365).

What is a CA17 form?

It is recommended that you take a Form CA-17 - Duty Status Report with you to give to your physician. This form provides your supervisor and OWCP with interim medical reports containing information as to your ability to return to any type of work.

How do I contact Owcp?

By calling 1-866-OWCP-IVR (1-866-692-7487), injured workers and their representatives may access information regarding case status, compensation payments, reimbursement of treatment and travel expenses, and authorization of medical treatment such as physical therapy and diagnostic testing.

How long can you receive OWCP?

After the initial 45 days, payments decrease to two-thirds of the regular wage amount (three-quarters if the employee has dependents). Compensation continues at this rate for an indefinite length of time based on the extent of the injury and what continued supporting documents the worker can provide.

What is a provider enrollment form?

In the most basic terms, provider enrollment (sometimes referred to as payer enrollment) is the process through which healthcare providers apply to be included in a health insurance network. As an in-network provider, you will be able to treat patients who carry that insurance and be reimbursed for your services.

How do I check the status of my OWCP claim?

Injured Workers, Providers, and Employing Agencies can check on the status of bills and reimbursements on the OWCP Web Bill Processing Portal. Claimant eligibility, bill status, and medical authorization inquiry functionality is also available 24 hours a day via our Interactive Voice Response (IVR) system.

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