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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.). Enter claimant's claim/case file number.
You can calculate mileage reimbursement in three simple steps: Select your tax year. Input the number of miles driven for business, charitable, medical, and/or moving purposes. Click on the "Calculate" button to determine the reimbursement amount.
How to properly fill out the Medical Mileage Form for Workers Compensation.Workers Comp Medical Mileage Form TutorialWorkers Compensation Reimbursement for M...
17 lut 2024 · 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.
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.
Instructions (Form OWCP-957) Enter claimant's full name: last name, first name, middle initial. Enter claimant's claim/case file number. Enter payee's full name (if person other than the claimant is to be reimbursed): last name, first name, middle initial. A payee other than the claimant must have special authorization.
There is a mileage reimbursement form that you can use to submit your request for California mileage reimbursement. For each trip you should provide: date; traveled from; traveled to; round trip miles; parking fees (if any) tolls (if any) You are required to sign and date the form. It is important to be completely truthful about your mileage ...
