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Payee s Certification I hereby certify that the information given by me on and in connection with this form is true and correct to the best of my knowledge and belief. I am aware that any person who knowingly makes any false statement or misrepresentation to obtain reimbursement from OWCP is subject to civil penalties and/or criminal prosecution. Date Form OWCP-957 Rev. Aug 2003 Instructions Form OWCP-957 1. U*S* Department of Labor Medical Travel Refund Request Reset Print Employment...
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How to fill out form 957 - wv
How to fill out owcp form 957:
01
Start by entering your personal information in the designated section. This includes your full name, address, and contact information.
02
Next, provide details about your employment. Include the name of your employer, your job title, and the date of your injury or illness.
03
Fill out the section asking for a description of your injury or illness. Be thorough and provide as much detail as possible, including when and how it occurred.
04
If you received any medical treatment related to your injury or illness, list the healthcare providers' names, addresses, and dates of treatment.
05
Indicate whether or not you missed work due to your injury or illness. If you did, provide information about any wages lost during that time.
06
Sign and date the form to certify the information you provided is true and accurate.
Who needs owcp form 957:
01
Employees who have suffered a work-related injury or illness and wish to file a compensation claim.
02
Individuals who are covered under the Federal Employees' Compensation Act (FECA) and seeking benefits.
03
Federal employees or their designated representatives who are responsible for initiating the claims process and providing necessary documentation.
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What is form 957?
Form 957 is a specific tax form used for reporting certain financial information.
Who is required to file form 957?
Individuals, businesses, and organizations meeting specific criteria are required to file form 957.
How to fill out form 957?
To fill out form 957, you need to provide the requested financial information in the designated sections of the form.
What is the purpose of form 957?
The purpose of form 957 is to collect financial information for tax reporting and compliance purposes.
What information must be reported on form 957?
Form 957 requires the reporting of various financial details such as income, expenses, assets, and liabilities.
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