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OWCP-957 Medical Travel Refund Request This form is available at http //www. dol.gov/esa/owcp/dfec/regs/compliance/OWCP-957.

How to fill out owcp form 957 printable

How to fill out OWCP 957 form?

1. Begin by obtaining a copy of the OWCP 957 form from the appropriate source, such as the Department of Labor's website or your employer's human resources department.
2. Carefully read the instructions provided on the form to familiarize yourself with the required information and any documentation that needs to be attached.
3. Start by filling out the basic personal information section, including your full name, contact details, and employee identification number.
4. Move on to the "Injury or Illness" section and provide a detailed description of the injury or illness, including the date and time it occurred, the circumstances surrounding it, and any medical treatment received.
5. If applicable, list any witnesses to the incident and provide their contact information.
6. Complete the "Employment Information" section, including your job title, salary, work schedule, and any additional relevant details regarding your employment.
7. Attach any necessary supporting documentation, such as medical records, accident reports, or witness statements, as indicated in the instructions.
8. Review and double-check all the information you have provided to ensure accuracy and completeness.
9. Once you are satisfied with the form, sign and date it in the designated space.
10. Make copies of the completed form and all accompanying documents for your records.

Who needs OWCP 957 form?

1. The OWCP 957 form is typically required for employees who have suffered a work-related injury or illness and are seeking compensation or benefits under the Federal Employees' Compensation Act (FECA).
2. This form is also necessary for individuals who are applying for compensation as a survivor of a deceased federal employee.
3. Employers may also require their employees to fill out the OWCP 957 form as part of their internal reporting and documentation process.

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What is owcp 957 form?

The OWCP 957 form, also known as the "Medical Travel Refund Request," is a document used by eligible federal employees who have incurred expenses related to medical treatment or examinations authorized by the Office of Workers' Compensation Programs (OWCP). This form is utilized to request reimbursement for travel, lodging, and other expenses associated with these authorized medical services. The OWCP evaluates the submitted form and supporting documents to determine if reimbursement is appropriate and to process any authorized reimbursement amounts.

Who is required to file owcp 957 form?

The OWCP-957 Form, also known as the "Registration for Electronic Funds Transfer," is required to be filed by federal employees who are receiving compensation benefits from the Office of Workers' Compensation Programs (OWCP) and wish to receive their payments electronically through direct deposit. This form is used to set up or update electronic funds transfer information, such as bank account details.

How to fill out owcp 957 form?

The OWCP 957 form, also known as the "Medical Travel Refund Request," is used to request reimbursement for travel expenses related to medical treatment obtained under the Federal Employees' Compensation Act (FECA). Here are the steps to fill out this form: 1. Download the OWCP 957 form from the U.S. Department of Labor's website or obtain a copy from your employing agency's OWCP representative. 2. Provide your personal information in section 1, including your name, mailing address, email address, and phone number. 3. In section 2, enter the name and address of the medical provider who treated you. 4. Indicate the type of expense incurred in section 3. Check the appropriate box for the expense type, such as "mileage reimbursement" or "taxi fare," and provide additional details as requested (e.g., starting and ending location for mileage reimbursement, receipt information for other expenses, etc.). 5. Fill out section 4 if you are requesting reimbursement for vehicle mileage. Provide the date(s) of travel, starting and ending locations, total miles traveled, and the purpose of the trip (e.g., medical treatment). 6. In section 5, declare whether or not you have authority to claim compensation from any other source (e.g., travel insurance) for the expenses listed. 7. Sign and date the form in section 6 to certify that the information provided is true and accurate. 8. Attach any supporting documentation, such as receipts or invoices, to substantiate your travel expenses. Make sure to keep copies of these documents for your own records. 9. Submit the completed OWCP 957 form along with supporting documentation to the appropriate OWCP office or your employing agency's OWCP representative. Keep a copy of the form and any attachments for your records. It is important to follow any additional instructions provided by your employing agency or the OWCP office to ensure the timely processing of your request.

What is the purpose of owcp 957 form?

The purpose of the OWCP 957 form refers to the "Employer's Supplemental Report of Accident" form used by the Office of Workers' Compensation Programs (OWCP) in the United States. This form is used to report work-related injuries or illnesses that occur within the federal government. Employers are required to complete and submit this form to the OWCP when an employee sustains a work-related injury or illness, providing details about the incident, including the nature of the injury, potential causes, and medical treatment received. The information provided on the OWCP 957 form helps the OWCP determine the eligibility and extent of benefits for the affected employee.

What information must be reported on owcp 957 form?

The OWCP (Office of Workers' Compensation Programs) Form 957, also known as the "Employment and Wage Information," must include the following information: 1. Employee Information: The full name, address, Social Security number, and date of birth of the injured employee. 2. Claim Information: The claim number assigned by OWCP, date of injury, and the employing agency. 3. Period of Employment: The beginning and ending dates of the claimant's employment with the agency. 4. Compensation Details: The claimant's regular wage rate, including any differentials or night pay, and the hours worked per day or week. 5. Injury Details: A description of the injury or occupational disease, including the body part affected and the cause of the injury. 6. Employment Status: Whether the claimant is currently employed, on leave without pay, or separated from employment. 7. Wage Information: The claimant's gross wages earned before the injury, including any overtime or bonuses, for the 52 weeks immediately preceding the injury. 8. Medical Treatment: Details of any medical treatment the claimant received due to the injury, including dates, providers, and costs. 9. Return to Work: If the claimant has returned to work, provide the date of return and whether it is with the same employer or a different job. 10. Additional Information: Any other pertinent information related to the claim, such as the claimant's contact information and any other benefits received, such as Social Security or long-term disability. It's important to note that specific requirements may vary depending on the nature of the claim and the jurisdiction. Therefore, it is advisable to consult the official OWCP guidelines and instructions for the accurate and complete completion of the Form 957.

What is the penalty for the late filing of owcp 957 form?

The Office of Workers' Compensation Programs (OWCP) enforces specific rules and regulations related to the timely filing of Form OWCP-957, also known as the "Forms to be used in making claim for compensation under the Federal Employees' Compensation Act." While there is no specific information available regarding penalties for the late filing of Form OWCP-957, it is generally essential to submit the form within the specified timeframe to ensure the timely processing of your claim. Late filing may result in delays in processing your claim or potentially having your claim denied. The specific consequences may depend on the individual circumstances, so it is advised to contact the OWCP or a legal professional specialized in federal workers' compensation for more accurate and detailed information in your situation.

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