Get Dol Owcp-957 2022-2025

Filling out the DoL OWCP-957 form online is a crucial step in obtaining reimbursement for medically related travel expenses. This guide provides clear, step-by-step instructions to assist users in accurately completing the form.

Follow the steps to successfully complete the DoL OWCP-957 form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the claimant's full name, including last name, first name, and middle initial.
3. Input the case or claim number associated with the claimant's medical expenses.
4. Provide the payee's name if it differs from the claimant's name, including last name, first name, and middle initial.
5. Fill in the address of the payee, including street/RFD, city, state, and zip code, ensuring it meets the requirements for the Federal Employees' Compensation claim if applicable.
6. Complete a separate block for each medical facility visited on the same day or for travel on different days. Enter the date of travel, mark the type of travel to and from the facility, and include the medical facility's name and address.
7. For each aspect of the trip (taxi, bus/train, lodging, meals, etc.), mark the boxes applicable to your expenses and note the corresponding costs for reimbursement.
8. If applicable, enter the total miles traveled by private automobile and ensure a physician's signature is included if necessary for verification.
9. Sign and date the certification indicating that the information provided is accurate to the best of your knowledge.
10. Attach all original receipts that correspond to your listed expenses, ensuring that each receipt has the claimant's full name and Social Security number.
11. Review all filled-out information for accuracy before submitting the completed form.
12. After completing all fields, you can save changes, download, print, or share the form as needed.

Complete your documents online today for hassle-free reimbursement.