Claimant’s Name


Dear {Claimant Name}:

This is the final decision in reference to the overpayment of benefits in the amount of {$ } in your {Part B and/or E} claim under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA or Act). After a thorough review of the financial information submitted, it has been determined that you do not meet the criteria for a waiver of the overpayment recovery.

{Provide explanation of how overpayment occurred.}

{Provide explanation of how the overpayment final decision was determined. If applicable, include a statement if the preliminary at fault finding was reversed.}

In response to an overpayment notice sent to you on {date}, you completed an Overpayment Recovery Questionnaire (OWCP-20) and requested a waiver of recovery of the overpayment. To support your request, you submitted the required financial information pertaining to your income, expenses, and assets. This determination is based on the financial documentation that you provided.

The EEOICPA Federal Procedure Manual at Chapter 3-0800.10.a states that an overpayment waiver may be granted if recovery would defeat the purpose of the EEOICPA. This means that it must be found that the claimant requires substantially all current income to meet current ordinary and necessary living expenses. To meet this criterion, the monthly income must not exceed monthly expenses by more than $200. In addition, the claimant’s countable assets must not exceed an amount as determined by data obtained from the Bureau of Labor Statistics (BLS). The countable asset limit is $5,500 for an individual and $9,200 for an individual and spouse, plus $1,100 for each dependent.

The information you provided shows that your household consists of you, {include spouse and number of children, if any}. The monthly household income is approximately {$ }. The monthly expenses that you submitted are approximately {$ }, and include {list type of expenses}. Based on this information, {state whether monthly income exceeds monthly expenses by more than $200 or it does not exceed monthly expenses by more than $200.}

With regard to your assets, your home and up to two motor vehicles are excluded from your countable assets. The information you submitted show that your countable assets include the following:

{List assets and value} $

Total Countable Assets $

The asset amount allowed for your household is {$ }. The known value of your countable assets is {$ }. {State whether assets are under or over the countable asset limit to qualify for a waiver.}

{State why claimant does not meet waiver criteria}

The EEOICPA Federal Procedure Manual at Chapter 3-0800.10.b states that an overpayment waiver may also be granted if recovery of the overpayment would violate equity and good conscience. The following is the criteria to qualify for a waiver under this clause:

1. A claimant would suffer severe financial hardship in trying to repay the debt;

2. A claimant, acting on incorrect information from DEEOIC, gives up a verifiably valuable right or changes his or her position for the worse, such as leaving a job which he or she cannot regain; or

3. A claimant, acting on incorrect information from DEEOIC, spends or commits funds in ways which he or she otherwise would not have done, and suffers a financial loss as a result.

I advised you of this clause and explained the criteria for a waiver. However, you did not provide any information to indicate that you would meet the waiver criteria.

The DEEOIC Policy Unit has reviewed the documentation submitted in support of your request for a waiver of recovery of the overpayment. The final determination with regard to the overpayment in your claim is that you do not meet the criteria for a waiver to be granted. Accordingly, you must return the overpaid compensation of {$ }.

In addition, as of the date of this decision, interest on this debt began accruing at the current U.S. Department of Treasury note rate of { %} annually. If you wish to repay the overpayment at this time and avoid the payment of interest, please send your full payment immediately. You may also request to enter into a repayment agreement to make monthly installment payments. If we do not receive your payment or request to enter into a repayment agreement within 30 days of the date of this letter, this will be a delinquent debt.

It is important to note that delinquent debts will be referred to the U.S. Department of Treasury for recovery. This referral is authorized under the Debt Collection Act, which also authorizes the assessment of interest, administrative costs, and penalties on delinquent debts. Various measures may be utilized to collect the debt, including administrative wage garnishment, offset of payments from federal programs such as income tax refunds, and referral of debts to private collection agencies and credit bureaus. The information that will be provided to a credit bureau includes your name, address, social security number, the amount, status, history of the debt, and the program under which the debt arose (Energy Employees Occupational Illness Compensation Program).

Certain rights are provided to you with respect to the referral of your debt to the Department of Treasury or credit bureaus. If you think that the determination regarding the debt is in error, you may request further information as noted below, and send your request to: DOL DEEOIC Central Mail Room, PO Box 8306, London, KY 40742-8306.

· You may request copies of your records about this debt.

· You may request a review of our determination about the amount of your debt, its past-due status, and its legal enforceability. To exercise this right, you must state your request in writing, state your reason(s) for challenging our determinations, and sign your statement. If you believe that any information of record concerning your debt is not accurate, timely, relevant, or complete, you must provide information or documentation to support your belief.

To pay the overpayment in full, send your payment in the amount of {$ } within 30 days of the date of this letter. Make your check or money order payable to “U.S. Dept. of Labor, OWCP/DEEOIC”. Please notate the case ID number on the check or money order and indicate that it is for an overpayment refund. Send the payment to: US Department of Labor, DEEOIC, PO Box 77247, Washington, DC 20013.

If you cannot repay the full amount at this time and would like to enter into a written repayment agreement, you should contact this office to make arrangements for installment payments. The Overpayment Recovery Questionnaire and supporting financial documentation will be used in setting up the repayment agreement.

If you have any questions about this letter or wish to set up an installment repayment plan, please contact me at {phone number} or 202-693-0081.


{PA name}

Policy Unit


Notice to Customers Making Payment by Check

When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment.

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting and collecting the information from your check, and explaining the purposes and routine uses which will be made of your check information, is available on internet site at: , or call toll free at 1-866-945-7920 to obtain a copy by mail. Furnishing the check information is voluntary, but a decision not to do so may require you to make payment by some other method.