Medical Travel Refund Request

ICR 202312-1240-003

OMB: 1240-0037

Federal Form Document

Forms and Documents

Document Name	Status
Form OWCP-957A Medical Travel Refund Request Form and Instruction	Modified
Form OWCP-957A Medical Travel Refund Request Form and Instruction	Modified
Justification for No material Nonsubtantive Change Request - 1240-0037.docx Justification for No Material/Nonsubstantive Change	2024-01-04
Justification for No material Nonsubtantive Change Request - 1240-0037.docx Justification for No Material/Nonsubstantive Change	2024-01-04
Medical Travel Request Form (OWCP-957)_exp 20240630.pdf Supplementary Document	2023-11-20
Medical Travel Request Form (OWCP-957)_exp 20240630.pdf Supplementary Document	2023-11-20
Medical Travel Request Form (OWCP-957B).pdf Supplementary Document	2023-11-20
Medical Travel Request Form (OWCP-957B).pdf Supplementary Document	2023-11-20
1240-0037 Medical Travel Request Form (OWCP-957A).pdf Supplementary Document	2023-11-20
1240-0037 Medical Travel Request Form (OWCP-957A).pdf Supplementary Document	2023-11-20
1240-0037 Supporting Statement_FINAL.docx Supporting Statement A	2023-09-19
1240-0037 Supporting Statement_FINAL.docx Supporting Statement A	2023-09-19
Energy Employees Occupational Illness Compensation Program Act (EEOICPA).pdf Supplementary Document	2021-04-30
Energy Employees Occupational Illness Compensation Program Act (EEOICPA).pdf Supplementary Document	2021-04-30
Employees Compensation Act.pdf Supplementary Document	2021-04-30
Employees Compensation Act.pdf Supplementary Document	2021-04-30
Black Lung Benefits Act.pdf Supplementary Document	2021-04-30
Black Lung Benefits Act.pdf Supplementary Document	2021-04-30
DOL ESA-49 (EEOICPA).docx Supplementary Document	2013-06-05
DOL ESA-49 (EEOICPA).docx Supplementary Document	2013-06-05
DOL ESA-6 (BLBA).docx Supplementary Document	2013-06-05
DOL ESA-6 (BLBA).docx Supplementary Document	2013-06-05
DOL GOVT-1 (FECA).docx Supplementary Document	2013-06-05
DOL GOVT-1 (FECA).docx Supplementary Document	2013-06-05

IC Document Collections

IC ID	Document Title	Status
38444	Medical Travel Refund Request Form and Instruction	Modified
38444	Medical Travel Refund Request Form and Instruction	Modified