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Tion Act (5 USC 8103(a)), the Black Lung Benefits Act (30 USC 901; 20 CFR 725.406 and 725.701) and the Energy Employees Occupational Illness Compensation Program Act of 2000, (42 USC 7384 and 20 CFR 30.701). While you are not required to respond, this information is required to obtain reimbursement for travel expenses. The method of collecting information complies with the Freedom of Information Act, the Privacy Act of 1974 and OMB Circ. 108. This form should be used for medically related travel.

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OWCP-957 - US Department of Labor
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CA-17 - Duty Status Report. This form allows the physician to keep your supervisor updated on your work restrictions and/or duty status.

Complete the OWCP-957 "Medical Travel Refund Request" form to request reimbursement for your transportation/mileage expenses. This form is available on the OWCP Web Bill Processing Portal. Write your OWCP claim number on the top right side of the form. You may record 3 trips on each form.

0:46 22:22 How to Fill In The CA 7, 7a, 7b - YouTube YouTube Start of suggested clip End of suggested clip File number or claim number and the date of injury are gonna be on your approval letter from OWCP.MoreFile number or claim number and the date of injury are gonna be on your approval letter from OWCP. So if you do forget it go ahead and get it from there. Your social is necessary.

Employing agency (EA) should submit completed Form CA-7 to the Office of Workers' Compensation Programs (OWCP) within five work days of receipt from IW. OWCP tries to review wage loss claims within five days of receipt, and take action to develop or pay within 14 days of receipt from EA.

Once the OWCP receives the completed OWCP-957 form and all necessary documentation, they will review the request and determine if the mileage is reimbursable under FECA. If approved, the OWCP will reimburse the employee at the current federal mileage rate, which is currently 58 cents per mile.

Complete the OWCP-957 “Medical Travel Refund Request” form to request reimbursement for your transportation/mileage expenses. This form is available online at http://owcp.dol.acs-inc.com – click on the “Forms and Links” link. Write your OWCP claim number on the top right side of the form.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232