Get Owcp Travel Fund Request Form

The OWCP Travel Fund Request Form is essential for individuals seeking reimbursement for medically related travel expenses under various federal programs. This guide provides a clear, step-by-step approach to successfully fill out the form online, ensuring you complete each section accurately and efficiently.

Follow the steps to accurately complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it for completion.
2. Begin by entering the claimant's full name in the designated field, including last name, first name, and middle initial.
3. Next, input the case or claim number provided in your documentation.
4. If the payee is different from the claimant, enter their name in the appropriate fields, specifying last name, first name, and middle initial.
5. Fill out the payee's address, ensuring to include street address, city, state, and zip code.
6. For each travel instance, complete the separate blocks starting with the date of travel and indicating whether it was a one-way or round trip.
7. Specify the travel origin by marking the relevant option: Hospital, Office/clinic, Lab, or Home.
8. Indicate the travel destination by marking the corresponding option, similar to the previous step.
9. Fill out the name and address of the medical facility visited.
10. List all claimed expenses for each transportation method and other expenses in the designated fields.
11. For travel using a private automobile, enter the total mileage traveled.
12. Include the physician's signature if required for the Black Lung benefit verification process.
13. The payee must certify the accuracy of the information by signing and dating the form.
14. Finally, attach all original receipts for the claimed expenses and ensure that the claimant's full name and Social Security Number are on each receipt. Save the completed form for submission.

Complete your OWCP Travel Fund Request Form online today to ensure timely reimbursement for your medical travel expenses.