Owcp 1240 0037-2026

1. Click ‘Get Form’ to open the OWCP 1240 0037 in the editor.
2. Begin by entering the claimant's full name in the designated field, ensuring you include the last name, first name, and middle initial.
3. Next, input the case or claim number accurately to link your request with your records.
4. If applicable, provide the payee's name if it differs from the claimant's. This is crucial for reimbursement processing.
5. Fill in the complete address of the claimant or payee, including street/RFD, city, state, and zip code.
6. For each medical facility visited on a specific date, complete a separate block. Enter the date of travel and mark whether it was a round trip or one-way.
7. List all expenses incurred for travel such as taxi fares or lodging. Ensure to attach original receipts for verification.
8. Finally, sign and date the form to certify that all information provided is accurate before submitting it through our platform.

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