skip to page content
Office of the Assistant Secretary for Policy

DOL Form OWCP-957

View OWCP's Form OWCP-957 Online htm
Agency: OWCP
Title: Medical Travel Refund Request
Form Description: The claimant completes the CM 957 to verify out of pocket medical travel expenses and to request reimbursement for these expenses. The information also ensures that the travel expenses are related to the minerís black lung condition.
OMB Control Number: 1215-0054