Medical Travel Refund Request

OMB 1240-0037

OMB 1240-0037

Requesting address change to OWCP-957 form. This form is used to request reimbursement for out-of-pocket expenses incurred when traveling to medical providers for covered medical testing or treatment.

The latest form for Medical Travel Refund Request expires 2021-06-30 and can be found here.

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