Justification for Non-sub Request 11-20-23

Justification for No material Nonsubtantive Change Request - 1240-0037_MN_clean.docx

Medical Travel Refund Request

Justification for Non-sub Request 11-20-23

OMB: 1240-0037

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Justification Supporting Nonsubstantive/No Material Change Request for

1240-0037 ‘Medical Travel Refund Request’ (OWCP-957)


The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is the agency responsible for administration of the Federal Employees’ Compensation Act (FECA), 5 U.S.C. 8101, the Black Lung Benefits Act (BLBA), 30 U.S.C. 901 and the Energy Employees’ Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 U.S.C. 7384. These statutes require OWCP to pay for appropriate medical and vocational rehabilitation services provided to beneficiaries.


Form OWCP-957 is used by OWCP and contractor bill processing staff to process reimbursement requests for all covered medical travel expenses, including mileage.


A 60-day Federal Register Noticing inviting public comments was posted in the Federal Register on 06/01/2023 to revise a single OWCP-957 form into a 2-part form which served to reduce burden. The system that processes the forms is not yet able to read the new fields that were added to the form (but it will be able to do so by the end of March) and the agency is requesting to use the previously approved form in the interim.




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSuggs, Anjanette C - OWCP
File Modified0000-00-00
File Created2023-11-21

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