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Click ‘Get Form’ to open the OWCP 957 in the editor.
Begin by entering the claimant's full name in the designated field, ensuring you include the last name, first name, and middle initial.
Next, input the claim or case number accurately to facilitate proper processing.
If a payee other than the claimant is requesting reimbursement, enter their full name and provide details about their relationship to the claimant.
Fill in the address of the payee, including street, city, state, and zip code. Ensure this is accurate for effective communication.
For each medical facility visited on the same day, complete a separate block. Enter the date of travel and mark whether it was a round trip or one-way.
List all expenses incurred during travel such as taxi fares or lodging costs in the respective fields provided.
Finally, ensure that you sign and date where indicated to certify that all information is true and accurate before submitting your form.
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20 CFR 10.315 - Will OWCP pay for transportation to obtain
(d) The standard form designated for medical travel refund requests is Form OWCP-957 and must be used to seek reimbursement under this section. This form can beRead more
This is a mileage only reimbursement form. If you need other travel expenses reimbursed, complete Form OWCP-957. Part B Medical Travel Refund Request - ExpensesRead more
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