Information Collection Request
Medical Travel Refund Request
ICR 202312-1240-003 · OMB 1240-0037 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0037 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form OWCP-957A Medical Travel Refund Request |
Form and Instruction | Modified | Available |
| Form OWCP-957A Medical Travel Refund Request |
Form and Instruction | Modified | Repair queued |
 Justification for No material Nonsubtantive Change Request - 1240-0037.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-01-04 | Available |
| Justification for No material Nonsubtantive Change Request - 1240-0037.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-01-04 | Repair queued |
 Medical Travel Request Form (OWCP-957)_exp 20240630.pdf |
Supplementary Document | Uploaded 2023-11-20 | Available |
| Medical Travel Request Form (OWCP-957)_exp 20240630.pdf |
Supplementary Document | Uploaded 2023-11-20 | Repair queued |
| Medical Travel Request Form (OWCP-957B).pdf |
Supplementary Document | Uploaded 2023-11-20 | Available |
| Medical Travel Request Form (OWCP-957B).pdf |
Supplementary Document | Uploaded 2023-11-20 | Repair queued |
| 1240-0037 Medical Travel Request Form (OWCP-957A).pdf |
Supplementary Document | Uploaded 2023-11-20 | Available |
| 1240-0037 Medical Travel Request Form (OWCP-957A).pdf |
Supplementary Document | Uploaded 2023-11-20 | Repair queued |
| 1240-0037 Supporting Statement_FINAL.docx |
Supporting Statement A | Uploaded 2023-09-19 | Available |
| 1240-0037 Supporting Statement_FINAL.docx |
Supporting Statement A | Uploaded 2023-09-19 | Repair queued |
| Energy Employees Occupational Illness Compensation Program Act (EEOICPA).pdf |
Supplementary Document | Uploaded 2021-04-30 | Available |
| Energy Employees Occupational Illness Compensation Program Act (EEOICPA).pdf |
Supplementary Document | Uploaded 2021-04-30 | Repair queued |
| Employees Compensation Act.pdf |
Supplementary Document | Uploaded 2021-04-30 | Available |
| Employees Compensation Act.pdf |
Supplementary Document | Uploaded 2021-04-30 | Repair queued |
| Black Lung Benefits Act.pdf |
Supplementary Document | Uploaded 2021-04-30 | Available |
| Black Lung Benefits Act.pdf |
Supplementary Document | Uploaded 2021-04-30 | Repair queued |
| DOL ESA-49 (EEOICPA).docx |
Supplementary Document | Uploaded 2013-06-05 | Available |
| DOL ESA-49 (EEOICPA).docx |
Supplementary Document | Uploaded 2013-06-05 | Repair queued |
| DOL ESA-6 (BLBA).docx |
Supplementary Document | Uploaded 2013-06-05 | Available |
| DOL ESA-6 (BLBA).docx |
Supplementary Document | Uploaded 2013-06-05 | Missing upstream |
| DOL GOVT-1 (FECA).docx |
Supplementary Document | Uploaded 2013-06-05 | Available |
| DOL GOVT-1 (FECA).docx |
Supplementary Document | Uploaded 2013-06-05 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 38444 |  Medical Travel Refund Request |
Form and Instruction | Modified | |
| 38444 | Medical Travel Refund Request |
Form and Instruction | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | DOL/OWCP |
| OMB Control No | 1240-0037 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202311-1240-004 |
| Date Submitted to OIRA | 2024-01-04 |
| Requested Expiration Date | 1969-12-31 |