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. In order 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. These forms can be viewed in an Internet Explorer browser window, but not in other browsers. If you are using Chrome or Firefox, follow these instructions to download PDF files and open them in Adobe Acrobat Reader.
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 to manually fill and submit. Simply click on the appropriate form and print it using the [Print] button provided near the top of the form. Write or type the required information on the hardcopy and authorize the form, if applicable, with a hand-written signature.
Simply click on the appropriate form, fill out the form using your computer keyboard and the <TAB> key or your mouse to navigate between form fields. Print the form (use the Print button on or near the top of the form), authorize the form (if applicable provide hand-written signature).
NOTE: When printing these files please remember to use the Adobe Acrobat Reader print icon or the [Print] button on the form, itself, and NOT your browser's print icon on the browser toolbar.
- 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.