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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
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.
Medical Travel Refund Request. 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.
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.
REQUEST FOR MILEAGE REIMBURSEMENT. CLAIM NUMBER: EMPLOYER: DATE OF ACCIDENT: CLAIMANT: DATE OF TRIP ADDRESS FROM. DESTINATION PARKING/TOLLS (Receipt must be includ; ed) NUMBER OF ... Author: Travelers Subject: Workers Compensation Request for Mileage Reimbursement Keywords: Workers Compensation Request for Mileage Reimbursement Created Date:
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.
In connection with the above workers compensation case, you are entitled to be reimbursed for (1) medications or supplies properly prescribed by your health care provider that you paid for yourself and for (2) fares, automobile mileage or other necessary expenses going to and from your health care provider's office or the hospital.
