Division of Energy Employees Occupational Illness Compensation (DEEOIC)
OWCP's DEEOIC has made a variety of forms available online. These forms are only available in PDF format. To view and/or print PDF documents you must have a PDF viewer. It is highly recommended that you have the most current version (click on Adobe Acrobat Reader to download the current version) available on your workstation.
The forms in the list below may be completed manually via the print form option or electronically via the electronic fill option:
All of the DEEOIC online forms are available to print and then manually fill and submit. Simply click on the appropriate form and print it using your internet browser’s print function. Write or type the required information on the hardcopy and sign, if applicable, with a hand-written signature.
The preferred method to complete the fillable forms is to download the form to your computer/device using your internet browser’s download function, then complete using Adobe Acrobat Reader. Print and sign (if applicable), with a handwritten signature; and submit by following the instructions on the form.
You may also fill out the form in your internet browser by selecting the form and filling out the form using your computer keyboard and your mouse to navigate between form fields. Print and sign (if applicable) with a handwritten signature; and submit by following the instructions on the form.
Please note that some forms may not have submittal instructions. For those forms, mail them to:
U.S. Department of Labor
P.O. Box 8306
London, KY 40742-8306
Additionally, you can use the Energy Document Portal (EDP) to either file a new claim or uploaded documents to existing claims. For more information on EDP, please visit: http://www.dol.gov/EnergyProgramEDP
- 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
- Claim for Home Health Care, Nursing Home, or Assisted Living Benefits: Form EE-17A
- Physician’s Certification of Medical Necessity: Form EE-17B
- General Medical Authorization Request: EE-22
- Durable Medical Equipment Authorization Request: EE-24
- Rehabilitative Therapies Authorization Request: EE-26
- Transportation Authorization Request: EE-28
- Transplant Authorization Request: EE-30
- Home Health Care Authorization Request: EE-32
- Reclamación del empleado: Formulario EE-1
- Reclamación de sucesor: Formulario EE-2
- Antecedentes laborales: Formulario EE-3
- Declaración jurada de antecedentes laborales: Formulario EE-4
- Requisitos médicos: Formulario EE-7
If you have questions or need assistance completing or submitting these forms, you can send DEEOIC a question via email by clicking DEEOIC-Public Mailbox. DEEOIC will respond to your question via email.