Get Owcp-957 2017-2025

The OWCP-957 form is essential for individuals seeking reimbursement for medical travel expenses under various compensation programs. This guide will walk you through the step-by-step process of accurately completing the form online to ensure a smooth reimbursement experience.

Follow the steps to successfully complete the 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 in the designated field. Be sure to include the last name, first name, and middle initial.
3. Input your claim or case number accurately in the specified box to ensure proper identification of your request.
4. If the payee is different from the claimant, enter the payee's full name, including last name, first name, and middle initial. Remember, special authorization may be necessary.
5. Provide the complete address for the payee, including street, city, state, and zip code. Ensure the address adheres to the requirements of the relevant compensation program.
6. Complete a separate block for each medical facility visited on the same day. For travels on different days, you should fill out a new block for each date.
7. In the travel section, select the appropriate options for travel from and to, indicating whether the travel was one-way or round trip.
8. Fill in the medical facility’s name and address where services were rendered.
9. Mark each box for which you are requesting reimbursement and list the expenses incurred for each item, ensuring to total your expenses accurately.
10. If applicable, enter the number of miles traveled if a private automobile was used.
11. The physician's signature or facsimile is needed on the form to validate the claim for services rendered.
12. Lastly, sign the payee's certification section and date the form to confirm the accuracy of the information provided.
13. Attach all original receipts relevant to the claimed expenses and ensure the claimant's full name and Social Security Number appear on each receipt before submission.
14. Save all changes made to the form, and ensure that you download or print a copy for your records. Share or submit the completed form as required.

Complete your OWCP-957 form online today to ensure you receive the reimbursements you're entitled to!