| Form Number | Form Description |
|---|---|
| Form EE-1 | Claim for Benefits under EEOICPA |
| Form EE-2 | Claim for Survivor Benefits under EEOICPA |
| Form EE-3 | Employment History for Claim under EEOICPA |
| Form EE-4 | Employment History Affidavit for Claim under the EEOICPA |
| Form EE-5 | Department of Energy Response to Employment History for Claim under the EEOICPA |
| Form EE-7 | Medical Requirements under the EEOICPA |
| Form EE/EN-8 | Racial/Ethnic Identification under EEOICPA |
| Form EE/EN-9 | Smoking History Identification under EEOICPA |
| Form EE-10 | Claim for Additional Wage-Loss and/or Impairment under the EEOICPA |
| Form EE/EN-11A | Impairment Benefits Response Form |
| Form EE/EN-11B | Wage-Loss Benefits Response Form |
| Form EE/EN-12 | Beneficiary Annual Report Form |
| Form EE-13/EN-13 | Request for Information with Respect to State Workers’ Compensation Claims |
| Form EE/EN-16 | Claimant Report Form |
| Form EE/EN-20 | Acceptance of Payment under the EEOICPA |
| Form DL 1-520 | Request under the Freedom of Information Act |
| Form ESA-67a | Privacy Act Record System Log of Disclosures |
| Form OWCP-04 | Uniform Bill for Medical Expenses |
| Form OWCP-915 | Claim for Medical Reimbursement |
| Form OWCP-957 | Medical Travel Refund Request |
| Form OWCP-1500 | Health Insurance Claim |
| Form SSA-581 | Authorization to Obtain Earnings Data from the SSA |