EEOICPA BULLETIN NO. 03-19

Attention: This bulletin has expired and is inactive.

Issue Date: March 17, 2003

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Effective Date: March 17, 2003

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Expiration Date: March 17, 2004

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Subject: Department of Energy requests for DEEOIC claimant files.

Background: The Department of Energy (DOE) is responsible for development and implementation of Part D of the Energy Employees Occupation Illness Compensation Program Act (EEOICPA) in which a DOE contractor employee or survivor can seek assistance from DOE in filing a claim with the appropriate State workers’ compensation system based on an illness or death that arose out of exposure to a toxic substance during the course of employment at a DOE facility.

Claimants who apply to DEEOIC often apply for assistance under DOE’s Program. Therefore, to assist the claimant in limiting the burden of duplicate requests for case development information, DEEOIC, under the routine use provision of the Privacy Act, will provide case information to the DOE on a case by case basis for the claimants who have applied to the DOL program and DOE for state assistance. DEEOIC information released to DOE is limited to the eligible DOE contractor employee and survivor filing the DOE claim.

It was discovered with the current process outlined in Bulletin 03-10, that the established point of contacts in the DO were unable to code ECMS if the case file was assigned to the Final Adjudication Branch (FAB) or the National Office. Changes have been made to the procedures which require FAB or the National Office to enter all required codes if the file is assigned to them.

Note— This bulletin replaces Bulletin 03-10, Department of Energy requests for DEEOIC claimant files.

Reference: Privacy Act of 1974, as amended (5 U.S.C 552a)

Purpose: To provide revised procedures for processing DOE record requests.

Applicability: All staff.

Action:

1. The DOE will submit the form Request for Department of Labor EEOICPA Case Information (Attachment 1) to the designated District Office Point of Contact (POC) via E-mail or Fax. Assignments for POC’s have been established by each District Office which are listed on Attachment 2. Faxed requests must be date stamped as soon as they are retrieved from the fax machine in the District Office and given to the designated point of contact.

2. Upon receipt of the request, the POC must determine if there is a record of the claim in ECMS. If the POC determines that ECMS does not have record of the file, the POC should complete section 2 "Acknowledgment of Records Sent" on page 2 of attachment 1, mark the box "no records for the named individual," and mail, fax or email the response to the DOE requestor designated on the request form. The POC should make a copy of the request and response and keep a separate file for such DOE requests.

3. If the POC determines that DO has a case for the named individual, he/she should enter the code DR (Documents Requested) under the claim status screen in ECMS. The status effective date should be the date in which the request was received by the POC via email. If the request is faxed, the status effective date is the date the document was date stamped as received by the DO.

4. If it is determined the file is with the Final Adjudication Branch (FAB), the POC must fax or forward the email to the FAB Manager in the appropriate District Office. If the file is at the National Office in FAB or the Branch of Policies, Regulations and Procedures, the POC must forward the request to the designated Branch Chief. The POC should include in the email or fax cover sheet the date the request was received and the need to process the request. The FAB or NO official should place a copy of the email or fax cover sheet in the case file. The FAB or NO official will be responsible for processing the request as outlined in this Bulletin, including entering the code DR (Documents Requested) under the claim status screen in ECMS. The status effective date should be the date on which the request was received by the POC via email. If the request is faxed, the status effective date is the date the document was date stamped as received by the DO.

5. The DEEOIC will not provide information to the DOE that the Resource Centers have already provided. Therefore, the processing official must review the request form (Attachment 1) to determine if the DOE indicated a date in which they received information from the Resource Center. If a date is provided by the DOE, the processing official should make copies of claimant records only after the date indicated by the DOE. The processing official must complete appropriate sections on page 2 of request form (Attachment 1). He/she must make a copy of the information requested by the DOE from the claimants file.

6. Upon making copies of the claimant’s record, and completion of the appropriate sections of the request form, the processing official must make a copy of the request form and place the copy in the claimant’s file.

7. Copies of records are limited to the employee and if applicable the survivor named on the DOE request. DEEOIC staff may be held personally liable for releases of information that violate the Privacy Act. Therefore, the processing official must review the copies to assure information is limited to the employee and the applicable survivor. For survivors not named on the DOE request form, a signed release by the survivor(s) must be provided to the DOL granting permission for DEEOIC to release his/her records.

8. The processing official will prepare and express mail the package to the requesting DOE official to include the signed original of page 2, "Acknowledgment of Records Sent," and the copied documents.

9. The processing official must enter the code DS (Documents Sent) under the claim status screen in ECMS. The status effective date should be the date reflected by the processing official on the request form, section "Acknowledgment of Records Sent."

10. There may be instances in which DEEOIC has records for an individual; however, it may be inappropriate or unnecessary to copy the file. Instances may include:

File is in beginning phase of development, i.e. employment verification or medical evidence is still being developed. Depending on the urgency of the claim, the DOE may want to resubmit the request at a later date when further DEEOIC development has occurred.

Recommended/Final Decisions issued based on a non- covered condition. DEEOIC does not develop employment information in cases for non-covered conditions and will not have substantial information in the case file to assist the DOE with case development. Additionally, DEEOIC does not develop medical evidence for non-covered conditions and therefore will not have any substantive medical information that will be of benefit to DOE.

Under such circumstances, the processing official should call the requestor in DOE and explain the status of the case. He or she should ask DOE whether the DOE wants to reconsider the request. If the DOE still wants a copy of the file, the processing official should copy and forward the package to the DOE according to the procedures in this bulletin (including coding ECMS). The processing official should only code ECMS with a "DR" and "DS" in circumstances when a copy of a file is sent to the DOE.

Upon further consideration, if the DOE determines that they do not need a copy of the file, the processing official must state in the comments section on page 2 of the request form that the "DOE requestor [enter name] withdrew request". The processing official must then copy the request for the case file and forward the original to the requestor at the DOE. The official must enter the code DW (Document Request Withdrawn) under the claim status screen in ECMS. The status effective date will be the date the DOE withdrew the request.

11. If at anytime the POC or FAB official has questions regarding the request made by the DOE, he/she may contact the DOE requestor directly via email or telephone.

12. Processing of the DOE request should not take more than 15 days. If at anytime the request reaches 15 days outstanding, the processing official must contact the DOE via e mail, fax or mail explaining the progress and or delay in processing the DOE’s request. The processing official must place a copy of the email, letter or transcribed telephone conversation in the claimant’s file.

13. If the processing official receives a duplicative request for file information, the official must check the claimant’s file to determine if any additional information was added to the file since the last request. If yes, the official must process the DOE request for the additional information, following the procedures outlined in this bulletin (including coding ECMS).

If no new information was entered into the file since the DOE’s last request, the official must complete appropriate sections on page 2 of the request form. In addition, in the comments section, he/she should state, "No new information added since the DOE’s request made on [enter date]. The official must then copy the request form for the case file, and forward the original to the requestor at the DOE.

Note-- For privacy reasons, when discussing claimant information via email, the processing official can not use the full name and social security number together in an email transmission. However, the use of the first three letters of the last name, along with the complete social security number and date of birth is permitted.

Disposition: Retain until the indicated expiration date.

PETER M. TURCIC

Director, for Division of Energy Employees

Federal Employees’ Compensation Occupational Illness Compensation

Distribution List No. 1: Claims Examiners, Supervisory Claims Examiners District

Medical Advisers, Systems Managers, Technical

Assistants, Rehabilitation Specialists, and

Staff Nurses, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Sections, ADP Coordinators

Date:

To: (DOL District Office)

From: (DOE Federal Official, phone number & address/email address)

[the named SSN] has filed for state assistance under Part D of the EEOICPA. To assist in the development of the case the Department of Energy requests copies of the documents indicated in the box below. The employee’s last place of employment was [list facility].

EMPLOYEE INFORMATION

Last First

(If emailing request, do not use full name with SSN, use only first three letters of last name and DOB)

Social Security Number Date of Birth

SURVIVOR INFORMATION (IF APPLICABLE)

Last First

(If emailing request, do not use full name with SSN, use only first three letters of last name and DOB)

Social Security Number Date of Birth

Please check box to indicate information needed from the DOL case file

□ Information added to file after Resource Center submission to DOE on {enter date

received from RC}

□ No records have been provided by Resource Center, please send all applicable records.

□ Other (specify):

Acknowledgement of Records Sent to the DOE –FOR DOL USE ONLY

The following section is to be filled out by the DOL District or FAB Office and sent to the DOE with the copied documents. A copy of the request and acknowledgement should be placed in the DOL case file.

Date:

Case file number:

The following records have been sent to DOE:

o No records for the named individual

o Information added to file after Resource Center submission to DOE on [enter date received

from RC]

o All claim records related to the employee or the named survivor. (Do not send documents related to other survivors from the case unless a signed release is provided by the DOE)

o No records sent

o Other (specify)

Comments:

DEEOIC Office:

DEEOIC Official:

Date Sent:

Contact Information for DOE Records Requests

District Office 1—Jacksonville, Florida

Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee

U.S. Department of Labor, DEEOIC

214 North Hogan Street, Suite 910

Jacksonville, FL 32202

(904) 357-4705 (main #)

Records Point of Contact

Shirley Stone Direct (904) 357-4795, Ext. 7-4404 Fax (904) 357-4704

Email: shstone@jac.dol-esa.gov

District Office 2—Cleveland, Ohio

Connecticut, Delaware, District of Columbia, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Puerto Rico, Rhode Island, Vermont, Virgin Islands, Virginia, West Virginia, and Wisconsin

U.S Department of Labor, DEEOIC

1001 Lakeside Avenue, Suite 350

Cleveland, OH 44114

(216) 802- 1300 (main #)

Records Point of Contact

Leila Tirone

E-mail: tironele@cle.dol-esa.gov Direct (216) 802-1350 Fax (216) 802-1308/1315

District Office 3- Denver, Colorado

Arkansas, Colorado, Kansas, Louisiana, Montana, Nebraska, New Mexico, North Dakota, Oklahoma, South Dakota, Texas, Utah, and Wyoming

U.S. Department of Labor, DEEOIC

1999 Broadway, Suite 1120

P.O. Box 46550

Denver, Co 80201-6550

(720) 264-3060 (main #)

Records Point of Contacts

John Martin (Primary) Valerie Saleh (CC Valerie on all requests)

Direct (720) 264-3087 Fax (720) 264-3099 Direct (720) 264-3066

Email jmartin@den.dol-esa.gov Email vsaleh@den.dol-esa.gov

District Office 4—Seattle, Washington

Alaska, Arizona, California, Hawaii, Idaho, Iowa, Marshall Islands, Missouri, Nevada, Oregon, and Washington

U.S. Department of Labor, DEEOIC

719 2^nd Avenue, Suite 601

Seattle, Washington 98104

(206) 373-6750 (main #)

Records Point of Contact

Sheila Wilson ; Direct (206) 373-6753 Fax (206) 373-6794

Email: swilson@sea.dol-esa.gov