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Get Dol Owcp-957 2003
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How to fill out the DoL OWCP-957 online
The DoL OWCP-957 form is essential for claiming reimbursement for medically related travel expenses. This guide provides clear, step-by-step instructions on how to accurately fill out the form online to facilitate your reimbursement request.
Follow the steps to complete your form effectively.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the claimant's full name in the format of last name, first name, and middle initial.
- Input the case or claim number assigned to the claimant.
- If the payee is different from the claimant, include their full name using the same format as step 2.
- Provide the address for the payee, including street or RFD, city, state, and zip code.
- For each medical appointment, follow these sub-steps: a) Input the date of travel; b) Indicate whether it's one-way or round trip; c) Specify travel from which location (hospital, office/clinic, lab, or home); d) Specify travel to which location (hospital, office/clinic, lab, or home); e) Provide the name and complete address of the medical facility; f) Mark the relevant reimbursement categories and total expenses incurred; g) If applicable, enter miles traveled for private auto use; h) Have the physician complete the required section if related to Black Lung.
- Repeat step 6 for any additional medical visits on the same or different days, ensuring each travel block is filled out completely.
- In the payee's certification section, the claimant or payee must sign and date the form to confirm the accuracy of the information provided.
- After completing the form, ensure you attach all original receipts for documented expenses, which must display the claimant's full name and Social Security Number.
- Finally, save your changes and, if needed, download, print, or share the completed form.
Complete your DoL OWCP-957 form online today for a smooth reimbursement process.
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OWCP death benefits encompass a variety of forms of financial aid granted to dependents of employees who experience work-related deaths. These benefits may include lump-sum payouts and ongoing compensation for eligible survivors. Familiarizing yourself with the DoL OWCP-957 can simplify your understanding of what these benefits entail and how to access them.
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