EEOICP Forms for Individuals or Households

Documents and forms in this information collection

Document Name	Document Type
Form EE-1 English Worker's Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act EEOICP Forms for Individuals or Households	Form and Instruction
Form EE-2 English Survivor's Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act EEOICP Forms for Individuals or Households	Form and Instruction
Form EE-3 English Employment History for a Claim Under The Energy Employees Occupational Illness Compensation Program Act EEOICP Forms for Individuals or Households	Form and Instruction
Form EE-4 English Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act EEOICP Forms for Individuals or Households	Form and Instruction
Form Form EE-8 and EN-8 Letter to Claimant EEOICP Forms for Individuals or Households	Form
Form EE-9 and EN-9 Letter to Claimant EEOICP Forms for Individuals or Households	Form
Form EE_10 and EN-10 Letter to Claimant EEOICP Forms for Individuals or Households	Form
Form EE-20 and EN-20 Letter to Claimant EEOICP Forms for Individuals or Households	Form and Instruction
Form EE-1 Spanish Reclamacion de beneficios segun la Ley del Programa de Indemnizaciom por Enfermedades Ocupacionales para Empleados del Sector de la Energia EEOICP Forms for Individuals or Households	Form and Instruction
Form EE-2 Spanish Reclaamacion de beneficios de sobreviviente segun las Ley del Programa de Indemnizacion por Enfermedades Ocupacionales para Empleados del Sector de las Energia EEOICP Forms for Individuals or Households	Form and Instruction
Form EE-3 Spanish Historial de empleo para reclamacion segun la Ley del Programa de Indemnizacion por Enfermedades Ocupscionales para Empleados del Sector de la Energia EEOICP Forms for Individuals or Households	Form and Instruction
Form EE-4 Spanish Declaracion jurada sobre historial de empleo para reclamacion sequin la Ley del Programa de Indemnizacioon por Enfermedades Ocupacionales para Empleados del Sector de la Energia EEOICP Forms for Individuals or Households	Form and Instruction
Form EE-11A and EN-11A Letter to Claimant EEOICP Forms for Individuals or Households	Form
Form EE-11B and EN-11B Letter to Claimant EEOICP Forms for Individuals or Households	Form
Form EE-12 and EN-12 Letter to Claimant EEOICP Forms for Individuals or Households	Form
Form EE-16 and EN-16 Letter to Claimant EEOICP Forms for Individuals or Households	Form
Form EE-17A CLAIM FOR HOME HEALTH CARE, NURSING HOME, OR ASSISTED LIVING BENEFITS UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT EEOICP Forms for Individuals or Households	Form and Instruction
Form EE-17B PHYSICIAN’S CERTIFICATION OF MEDICAL NECESSITY UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION EEOICP Forms for Individuals or Households	Form and Instruction
EE-1 English Worker's Claim for Benefits Under the Energy Employees O EE-1.docx www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm	Form and Instruction
EE-2 English Survivor's Claim for Benefits Under the Energy Employees EE-2.docx www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm	Form and Instruction
EE-3 English Employment History for a Claim Under The Energy Employee EE-3.docx www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm	Form and Instruction
EE-4 English Employment History Affidavit for a Claim Under the Energ EE-4.docx www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm	Form and Instruction
Form EE-8 and EN-8 Letter to Claimant EE-8 with EN-8.docx	Form
EE-9 and EN-9 Letter to Claimant EE-9 with EN-9.doc	Form
EE_10 and EN-10 Letter to Claimant EE-10 with EN-10.docx	Form
EE-20 and EN-20 Letter to Claimant EE-20 with EN-20.doc	Form and Instruction
EE-1 Spanish Reclamacion de beneficios segun la Ley del Programa de I EE-1-Spa.docx www.dol.gov/owcp/energy/regs/complaince/claimsforms.htm	Form and Instruction
EE-2 Spanish Reclaamacion de beneficios de sobreviviente segun las Le EE-2-Spa.docx www.dol.gov/owcp/energy/regs/complaince/claimsforms.htm	Form and Instruction
EE-3 Spanish Historial de empleo para reclamacion segun la Ley del Pr EE-3-Spa.docx www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm	Form and Instruction
EE-4 Spanish Declaracion jurada sobre historial de empleo para reclam EE-4-Spa.docx www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm	Form and Instruction
EE-11A and EN-11A Letter to Claimant EE-11A with EN-11A.docx	Form
EE-11B and EN-11B Letter to Claimant EE-11B with EN-11B.docx	Form
EE-12 and EN-12 Letter to Claimant EE-12 with EN-12.doc	Form
EE-16 and EN-16 Letter to Claimant EE-16 with EN-16.docx	Form
EE-17A CLAIM FOR HOME HEALTH CARE, NURSING HOME, OR ASSISTED LI EE-17A.docx	Form and Instruction
EE-17B PHYSICIAN’S CERTIFICATION OF MEDICAL NECESSITY UNDER THE EE-17B.docx	Form and Instruction

            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.