Division of Energy Employees Occupational Illness Compensation (DEEOIC)
Instructions on How to file a claim under the EEOICPA
- How to File a Claim for Employee Benefits under the EEOICPA
- How to File a Claim for Survivor Benefits under the EEOICPA
Filing a Claim
The Division of Energy Employees Occupational Illness Compensation (DEEOIC) has made a variety of forms available on-line. These forms may be completed and submitted to DEEOIC using the “Print Form and Mail Option.”
Note that all the electronic forms listed below are only available in PDF format. In order to view and/or print PDF documents you must have a PDF viewer (for example, the free Adobe Acrobat Reader) available on your workstation. Also, when printing these forms please remember to use the Adobe Acrobat Reader PRINT icon at or near the top of the form and not your browser's print icon.
Print Form and Mail Option
All DEEOIC forms listed below are available on-line to complete, print and submit via U.S. MAIL. Simply click on the appropriate form to begin. Then fill in the required information using your computer keyboard and print the form using the Adobe Acrobat Reader PRINT icon. You may hand write any additional information on the printed hard copy. You may decline the option to apply for a digital signature and instead sign the form with your hand-written signature. Finally, you can mail the completed form to the appropriate DEEOIC District office.
Submit the claim to the District Office that has jurisdiction over the state where the employee last worked for a Department of Energy employer. Click on the link below for a map of District Office jurisdictions. If you are submitting a claim for supplemental benefits from individuals who have received an award from the Department of Justice under Section 5 of the Radiation Exposure Compensation Act (RECA), send your claim to the Denver District Office.
In Person or over the Phone Option
The U.S. Department of Labor’s Division of Energy Employees Occupational Illness Compensation (DEEOIC) established 11 Resource Centers nationwide to assist workers and their families apply for benefits under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). Resource Centers are located in Livermore, California; Westminster, Colorado; Idaho Falls, Idaho; Paducah, Kentucky; Espanola, New Mexico; Las Vegas, Nevada; Buffalo, New York; Portsmouth, Ohio; North Augusta, South Carolina; Oak Ridge, Tennessee; and Richland, Washington.
The Resource Centers can assist claimants in completing the necessary forms, provide valuable information about the claims process to claimants, and transmit documents to the DEEOIC District Offices. The Resource Centers can provide assistance either in person or over the telephone, and thus are able to service individuals who are outside the immediate geographical area. The resource centers also conduct outreach activities to inform the public of benefits and requirements of the EEOICPA.
The complete list of Resource Centers, including regional jurisdiction and contact information, and toll-free numbers can be found at the DEEOIC website.
- Employee's Claim: Form EE-1
- Survivor's Claim: Form EE-2
- Employment History: Form EE-3
- Employment History Affidavit: Form EE-4
- Medical Requirements: Form EE-7
- Physician/Provider Billing Form: OWCP-1500
- Reimbursement for out-of-pocket medical expenses: OWCP-915
- Uniform Billing Form for Medical Services: OWCP-04
- Medical Travel Refund Request: OWCP-957
- Direct Deposit Sign-up Form SF-1199A
If you have questions or need assistance completing or submitting these forms, you can send DEEOIC a question via e-mail by clicking DEEOIC-FormsAssistance. DEEOIC will respond to your question via e-mail.