DOL OWCP-957 Part A 2023-2025 free printable template
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Medical Travel Refund Request Mileage. S. Department of Labor
Office of Workers\' Compensation ProgramsNOTE: This report is authorized by the Federal Employees\' Compensation Act (5 USC 8103(a)) and
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How to fill out 957 owcp form
How to fill out DOL OWCP-957 Part A
01
Begin by entering your personal information at the top of the form, including your name, address, and contact details.
02
Provide your Social Security Number (SSN) in the designated area.
03
Fill in the date of your birth and the date of the injury or illness.
04
Indicate your employment details, including the name of your employer, job title, and the period of employment.
05
Describe the nature of your injury or illness in detail, including how and when it occurred.
06
Provide information regarding any medical treatment you have received.
07
Include any relevant documents or evidence to support your claim.
08
Review the completed form for accuracy before submitting it.
Who needs DOL OWCP-957 Part A?
01
Individuals who are filing a claim for workers' compensation benefits under the Federal Employees' Compensation Act (FECA) due to a work-related injury or illness.
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What is DOL OWCP-957 Part A?
DOL OWCP-957 Part A is a form used by the U.S. Department of Labor's Office of Workers' Compensation Programs to collect information about an employee's work-related injury or illness. It is part of the process for claiming benefits under the Federal Employees' Compensation Act (FECA).
Who is required to file DOL OWCP-957 Part A?
Employees who have sustained a work-related injury or illness and are seeking benefits under the FECA are required to file DOL OWCP-957 Part A. Employers may also need to complete parts of the form during the claims process.
How to fill out DOL OWCP-957 Part A?
To fill out DOL OWCP-957 Part A, individuals must provide personal information, details of the injury or illness, the circumstances surrounding it, and any medical treatment received. It's important to follow the instructions provided with the form and ensure all information is accurate.
What is the purpose of DOL OWCP-957 Part A?
The purpose of DOL OWCP-957 Part A is to provide the necessary details that facilitate the processing of claims for workers' compensation benefits. It helps the DOL evaluate the eligibility of the injured employee for benefits under FECA.
What information must be reported on DOL OWCP-957 Part A?
DOL OWCP-957 Part A requires reporting personal details such as the claimant's name, social security number, and employment information, along with specifics regarding the injury or illness, including date, time, and nature of the incident, as well as any medical treatment information.
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