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U.S. Department of Labor Medical Travel Refund Request Reset Print Employment Standards Administration Office of Workers Compensation Programs OMB No. 12150054 Expires: 06/30/2007 NOTE: This report

How to fill out owcp-957 owcp medical travel

How to fill out owcp-957 owcp medical travel:

1. Start by obtaining the owcp-957 form from the Department of Labor's website or your local OWCP office.
2. Fill out the first section of the form, providing your personal information such as your name, address, and contact details.
3. Proceed to the next section and provide details about your employment, including your job title, the agency you work for, and your pay grade.
4. In the following section, indicate the purpose of your travel by selecting the appropriate option (e.g., initial treatment, follow-up visit, second opinion).
5. Provide information about your healthcare provider, including their name, address, and contact details, as well as their specialty and credentials.
6. Describe the medical condition or injury that necessitates the travel, providing specific details about the diagnosis, treatment required, and any previous medical history relevant to the current situation.
7. Next, indicate the dates of your anticipated travel and specify the mode of transportation you will be using (e.g., air, rail, personal vehicle).
8. If you require any assistance during your travel due to physical limitations, make sure to indicate that in the appropriate section.
9. Review the completed form for accuracy, ensuring that all necessary sections have been filled out.
10. Sign and date the form before submitting it to the appropriate OWCP office or mailing it as instructed.

Who needs owcp-957 owcp medical travel:

1. Individuals who have suffered work-related injuries or illnesses and require medical treatment that is not available in their local area.
2. Employees who have been approved for travel expenses reimbursement under the Federal Employees' Compensation Act (FECA) administered by the Office of Workers' Compensation Programs (OWCP).
3. Those who need to document their medical travel for compensation or insurance purposes.

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What is owcp-957 owcp medical travel?

OWCP-957 OWCP medical travel is a form used to report medical travel expenses for individuals covered by the Office of Workers' Compensation Programs (OWCP).

Who is required to file owcp-957 owcp medical travel?

Employees who are covered by OWCP and incur medical travel expenses are required to file OWCP-957 OWCP medical travel.

How to fill out owcp-957 owcp medical travel?

OWCP-957 OWCP medical travel form can be filled out by providing information about the individual, the medical provider, and details of the travel expenses incurred.

What is the purpose of owcp-957 owcp medical travel?

The purpose of OWCP-957 OWCP medical travel is to report and claim reimbursement for medical travel expenses incurred by individuals covered under OWCP.

What information must be reported on owcp-957 owcp medical travel?

Information such as the name of the individual, medical provider, date of travel, mode of transportation, and expenses incurred must be reported on OWCP-957 OWCP medical travel.