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United States Department of Labor Employees Compensation Appeals Board ___ V.J., Appellant and U.S. POSTAL SERVICE, POST OFFICE, Charlotte, NC, Employer ___)) )) )) ))Appearances: Appellant, pro SE

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How to fill out 21-0130 tw and department

01

Fill out personal information in section 1 of form 21-0130 TW.

02

Fill out information about the medical facility and treatment in section 2 of form 21-0130 TW.

03

Provide details about the claim in section 3 of form 21-0130 TW.

04

Sign and date the form in section 4 of form 21-0130 TW.

05

Submit the completed form to the appropriate department.

Who needs 21-0130 tw and department?

01

Veterans who are seeking reimbursement for medical treatment expenses incurred outside of Department of Veterans Affairs facilities.

02

Department staff who process reimbursement claims for veterans' medical treatment expenses.

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