Get Dol Owcp-957 Part A 2023-2026

Filling out the DOL OWCP-957 Part A form can be essential for obtaining reimbursement for medical travel mileage. This guide provides step-by-step instructions that are clear and concise to assist users in completing the form efficiently.

Follow the steps to fill out the form accurately

1. Click ‘Get Form’ button to access the DOL OWCP-957 Part A form for completion.
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 case or claim number associated with the individual seeking reimbursement.
4. If the payee is not the claimant, provide their full name (last name, first name, middle initial) in the appropriate section.
5. Enter the phone number for the claimant or payee, as this may be necessary for follow-up questions regarding the form.
6. Fill in the complete address for the claimant or payee, including house number, street, city, state, and zip code. Ensure this is the home address and not a P.O. Box.
7. Provide an email address for the claimant or payee for further communication related to the reimbursement.
8. For every trip, fill out a separate block with the following details: date of travel, reason for travel, 'from' address (start location), 'to' address (destination), one-way or round trip selection, and the total number of miles traveled.
9. Review the payee certification statement carefully, ensuring the information is accurate and true, before signing and dating the form.
10. Once all fields are completed, you may save the changes, download a copy, print it, or share the form as necessary.

Take the next step and complete your DOL OWCP-957 Part A form online for a smoother reimbursement process.