Follow the steps to successfully complete your OWCP-957 form online.

1. Click ‘Get Form’ button to obtain the OWCP-957 and open it in your editor of choice.
2. Enter the claimant's full name in the designated field, ensuring to include the last name, first name, and middle initial.
3. Input the claim or case number assigned to the claimant in the appropriate section.
4. If the payee, who is receiving the reimbursement, is different from the claimant, fill in the payee's full name, which includes their last name, first name, and middle initial.
5. Provide the address for the payee in the specified format: Street/RFD, City, State, and Zip Code.
6. Complete sections 5, 6, and 7 for each medical facility visited on the same day. If visits span different days, create a separate entry for each day. Include the date of travel in the format requested.
7. In the marked sections, choose only one box for each type of travel—mark whether the travel was one-way or a round trip.
8. Enter the name and address of the medical facility in the allocated field.
9. In the reimbursement section, mark each applicable box and input the amount spent on each related expense.
10. If using a private automobile, specify the total number of miles traveled in the designated area.
11. Obtain the required physician's signature or facsimile, ensuring that their details align with Black Lung program requirements.
12. Before submitting, carefully review all entries for accuracy and completeness. Sign and date the form where indicated.
13. Attach all original receipts for expenses listed in the form's reimbursement sections. Ensure your full name and Social Security Number are on each receipt.
14. Finalize your application by saving changes, downloading, printing, or sharing the completed OWCP-957 form.

Complete your OWCP-957 form online today to ensure prompt reimbursement for your medical travel expenses.