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Medical Travel Refund Request
OMB 1215-0054
OMB.report
DOL/ESA
OMB 1215-0054
OMB 1215-0054
Latest Forms, Documents, and Supporting Material
Document
Name
Form OWCP-957 Medical Travel Refund Request
Form and Instruction
SS 1215-0054 2006.doc
Supporting Statement A
DOL ESA-49 (EEOICPA).doc
Supplementary Document
DOL ESA-6 (BLBA).doc
Supplementary Document
DOL GOVT-1(FECA).doc
Supplementary Document
Medical Travel Refund Request
Form and Instruction
All Historical Document Collections
200611-1215-009
Approved without change
Extension without change of a currently approved collection
2007-05-22
200506-1215-007
Approved without change
No material or nonsubstantive change to a currently approved collection
2005-06-29
200404-1215-004
Approved without change
Extension without change of a currently approved collection
2004-04-16
200304-1215-004
Approved without change
No material or nonsubstantive change to a currently approved collection
2003-04-09
200203-1215-006
Approved without change
No material or nonsubstantive change to a currently approved collection
2002-03-21
200108-1215-002
Approved without change
No material or nonsubstantive change to a currently approved collection
2001-08-03
200105-1215-001
Approved without change
Extension without change of a currently approved collection
2001-05-25
199807-1215-006
Approved without change
Extension without change of a currently approved collection
1998-07-31
199506-1215-002
Approved without change
Extension without change of a currently approved collection
1995-06-21
199206-1215-002
Approved without change
Revision of a currently approved collection
1992-06-11
198906-1215-002
Approved without change
Revision of a currently approved collection
1989-06-14
198607-1215-002
Approved without change
Revision of a currently approved collection
1986-07-15
198309-1215-005
Approved without change
Revision of a currently approved collection
1983-09-22
198206-1215-015
Approved with change
No material or nonsubstantive change to a currently approved collection
1982-06-30
197808-1215-013
Approved without change
Revision of a currently approved collection
1978-08-17
197410-1215-003
Approved without change
Revision of a currently approved collection
1974-10-04
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