Quick Start

Type directly into the official fillable PDF.
Use Save / Download and the PDF viewer download icon to save a completed copy.
Use Open Saved Form later to retrieve that PDF.
Print when ready and follow the agency's submission instructions.

Works inside MedClaimSoftware

This resource uses a browser-compatible local copy of the government form, so it does not depend on the agency website allowing an embedded PDF.

What this form is for

Use this form to request reimbursement for eligible out-of-pocket medical treatment, prescription medication, or medical supply expenses.

Agency: U.S. Department of Labor — OWCP

Your data stays local

MedClaimSoftware does not receive the information you type into the form. Save the completed PDF to a location you control.

Before submitting

Follow the current OWCP instructions for supporting documentation and where the reimbursement request must be sent.

Check the current official instructions →

Current file

OWCP-915 — blank official form

Chrome or Microsoft Edge is recommended for fillable PDF fields, saving, and printing.

The embedded PDF did not load.

The form is stored locally on MedClaimSoftware so it can open inside this workspace. If your browser does not show its PDF viewer, click Open Full Screen.