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This form should be used for medically related travel covered by the Federal Employees' Compensation Act and the Energy Employees Occupational Illness Compensation Program Act of 2000. For travel expenses reimbursement under the Black Lung Benefits Act (30 USC 901; 20 CFR 725.406 and 725.701) use the Form OWCP-957 Part B OMB No. 1240-0037
This form should be used for medically related travel covered by the Federal Employees' Compensation Act, the Black Lung Benefits Act and the Energy Employees Occupational Illness Compensation Program Act of 2000.
We have made the process of filing for medical travel reimbursement easier with two new streamlined forms. OWCP-957A - Medical Travel Refund Request – Mileage. OWCP-957B - Medical Travel Refund Request – Expenses. Federal Employees. Nuclear Weapons Workers.
Attention OWCP Claimants: Effective Feb 17, 2024, new OWCP-957 Medical Travel Refund Request forms will be available for mileage (957A) and expenses (957B). Follow this link to view further information.
Instructions – Form OWCP-957 Part A – Medical Travel Refund Request – Mileage. This is a mileage only reimbursement form. If you need other travel expenses reimbursed, complete Form OWCP-957 Part B Medical Travel Refund Request - Expenses. Enter claimant's full name: last name, first name, middle initial (M.I.).
Depending upon your agency, start by filing OSHA's Form 301, then file a claim using either form CA-1 (for traumatic injury) or form CA-2 (for occupational disease). After you have received an official FECA case number, you may also file form CA-7 (Claim for Compensation).
form should be used for medically related travel covered by the Federal Employees' Compensation Act, the Black Lung Benefits Act, and the Energy Employees Occupational Illness Compensation Program Act of 2000.
Effective February 17, 2024, you must use and complete the new Medical Travel Refund Request- Expenses, OWCP-957B form, to obtain reimbursement for mileage cost, and other expenses for travel related to medical treatment for your covered Black Lung condition.
This form should be used for medically related travel covered by the Federal Employees' Compensation Act, the Black Lung Benefits Act and the Energy Employees Occupational Illness Compensation Program Act of 2000.
Requirements for Reimbursement of the OWCP 957A and 957B Forms. Original receipts are required for lodging, airfare, rental car, and any other expense that exceeds $75. Claimant’s last name and OWCP Claim Number must be listed on submitted attachments. Be sure to keep a copy for your records.