ICR Documents

Supporting Statement A Document Date Uploaded 1240-0037 Supporting Statement_FINAL.docx 09/19/2023 Supporting Statement B Document Date Uploaded Supplementary Documents Title Document Document Type Date Uploaded DOL/GOVT-1 (FECA) DOL GOVT-1 (FECA).docx Supplementary Document 06/05/2013 DOL/ESA-6 (BLBA) DOL ESA-6 (BLBA).docx Supplementary Document 06/05/2013 DOL/ESA-49 (EEOICPA) DOL ESA-49 (EEOICPA).docx Supplementary Document 06/05/2013 Black Lung Benefits Act Black Lung Benefits Act.pdf Supplementary Document 04/30/2021 Employees Compensation Act Employees Compensation Act.pdf Supplementary Document 04/30/2021 Energy Employees Occupational Illness Compensation Program Act (EEOICPA) Energy Employees Occupational Illness Compensation Program Act (EEOICPA).pdf Supplementary Document 04/30/2021 Form 957 Part A - Mileage 1240-0037 Medical Travel Request Form (OWCP-957A).pdf Supplementary Document 11/20/2023 Medical Travel Request Form (OWCP-957B) - Expenses Medical Travel Request Form (OWCP-957B).pdf Supplementary Document 11/20/2023 Medical Travel Request Form (OWCP-957) Medical Travel Request Form (OWCP-957)_exp 20240630.pdf Supplementary Document 11/20/2023 Medical Travel Refund Request - Mileage (OWCP 957A) OWCP-957A December 2025 updates.docx Supplementary Document 01/07/2026 Medical Travel Refund Request - Expenses (OWCP-957B) OWCP-957B December 2025 updates.docx Supplementary Document 01/07/2026 Justification for 1240-0037 'Medical Travel Refund Request (OWCP-957B) Justification for 1240-0037 Medical Travel Refund Request - Expenses (OWCP-957B) 20260107.docx Justification for No Material/Nonsubstantive Change 01/07/2026 Justification for 1240-0037 'Medical Travel Refund Request - Mileage (OWCP-957A) Justification for 1240-0037 Medical Travel Refund Request - Mileage (OWCP-957A).docx Justification for No Material/Nonsubstantive Change 01/07/2026 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received