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Get Dol Owcp-957 2017
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How to fill out the DoL OWCP-957 online
This guide provides comprehensive and user-friendly instructions on completing the DoL OWCP-957 form online. This document is essential for requesting reimbursement for medical travel expenses related to workers' compensation.
Follow the steps to fill out the DoL OWCP-957 form accurately.
- Press the ‘Get Form’ button to obtain the form and open it for editing.
- Enter the claimant's full name in the format: last name, first name, middle initial in the designated field.
- Input the claim or case number in the specified section to link your request to the appropriate case.
- If the payee differs from the claimant, provide the full name (last name, first name, middle initial) of the payee and explain their relationship to the claimant.
- Fill in the address of the payee, ensuring to include the street address, city, state, and zip code. Note any specific requirements for claim types.
- Complete separate blocks for each medical facility visited on the same day. Include the date of travel and select the type of travel from the options provided.
- List the total expense for each item you are claiming, including taxi, bus, lodging, and other categories as applicable, along with the amounts.
- If applicable, provide the total miles traveled by private automobile in the respective field.
- Have the physician complete the verification section if Black Lung services were received, ensuring all necessary signatures are secured.
- Certify the information by signing the designated section and dating the form. Reminder to attach all original receipts for the claimed expenses.
- Review all information for accuracy. Save changes, download, print, or share the completed form as needed.
Complete your DoL OWCP-957 form online today to streamline your reimbursement process!
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When claiming mileage on Schedule C, ensure that your travel is directly related to your business activities. Record your mileage accurately and keep necessary documents for verification. Providing this information clearly, alongside the DoL OWCP-957, helps support your claim for mileage expenses.
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