DOL Form EEOICP EE-4

View OWCP-EEOICP's Form EEOICP EE-4 Online htm

Agency:

OWCP-EEOICP

Title:

EEOICP EE-4, Employment History Affidavit for Claim Under Energy Employees Occupational Illness Compensation Program Act

Form Description:

EEOICP EE-4, Employment History Affidavit for Claim Under Energy Employees Occupational Illness Compensation Program Act: Applicants use this form to submit an Employment History Affadavit for a claim under the EEOICPA.

OMB Control Number:

1215-0197