OMB control number
Medical Travel Refund Request
OMB 1240-0037 · DOL/OWCP.
OMB 1240-0037
OWCP must reimburse beneficiaries for travel expenses for covered medical treatment. In order to determine whether amounts requested as travel expenses are appropriate, OWCP must receive certain data elements, including the signature of the physician for medical expenses claimed under the BLBA. Form OWCP-957 is the standard format for the collection of these data elements. The regulations implementing these three statutes allow for the collection of information needed to enable OWCP to determine if reimbursement requests for travel expenses should be paid.
The latest form for Medical Travel Refund Request expires 2026-11-30 and can be found here.
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Form OWCP 957B Medical Travel Refund Request - Expenses
Medical Travel Request Form (OWCP-957)_exp 20240630.pdf
Medical Travel Refund Request All Historical Document Collections