Justification for No material/Nonsubstantive Change for EE1, EE-1-SPA, EE-2, EE-2-SPA, EE-17A and EE-17B

Justification EE-1 EE-1 SPA EE-2 EE-2 SPA EE-17 and EE-17B.docx

Energy Employees Occupational Illness Compensation Program Act Forms

Justification for No material/Nonsubstantive Change for EE1, EE-1-SPA, EE-2, EE-2-SPA, EE-17A and EE-17B

OMB: 1240-0002

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Justification for No material/Nonsubstantive Change

EE-1, Worker’s Claim for Benefits under the Energy Employees Occupational Illness Compensation Act

EE-1-SPA, Reclamación de beneficios según la Ley del Programa de Indemnización por Enfermedades Ocupacionales para Empleados del Sector de la Energía

EE-2, Survivor’s Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act

EE-2-SPA, Reclamación de beneficios de sobreviviente según la Ley del Programa de Indemnización por Enfermedades Ocupacionales para Empleados del Sector de la Energía

EE-17A, Claim for Home Health Care, Nursing Home, or Assisted Living Benefits Under the Energy Employees Occupational Illness Compensation Program Act

EE-17B, Physician’s Certification of Medical Necessity Under the Energy Employees Occupational Illness Compensation Program Act



The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is the agency responsible for administration of the Federal Employees’ Compensation Act (FECA), 5 U.S.C. 8101 et. seq., the Black Lung Benefits Act (BLBA), 30 U.S.C. 901 et. seq. and the Energy Employees’ Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 U.S.C. 7384 et. seq.  These statutes require OWCP to pay for appropriate medical and vocational rehabilitation services provided to beneficiaries. OWCP is requesting an address change to OWCP billing forms EE-1, Worker’s Claim for Benefits under the Energy Employees Occupational Illness Compensation Act, EE-1-SPA, Reclamación de beneficios según la Ley del Programa de Indemnización por Enfermedades Ocupacionales para Empleados del Sector de la Energía, EE-2, Survivor’s Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act, EE-2-SPA, Reclamación de beneficios de sobreviviente según la Ley del Programa de Indemnización por Enfermedades Ocupacionales para Empleados del Sector de la Energía, EE-17A, CLAIM FOR HOME HEALTH CARE, NURSING HOME, OR ASSISTED LIVING BENEFITS UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT, EE-17B, PHYSICIAN’S CERTIFICATION OF MEDICAL NECESSITY UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT in order for the new OWCP medical bill processor to receive and reimburse medical bills to medical providers.


Approval of this request is needed by April 17, 2020 for posting of the form on the new medical bill processors web portal. This will allow ample time for the new bill processor’s assumption of operations on April 27, 2020.  Any approval date beyond would necessitate a delay in operations go-live until the request is approved.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSuggs, Anjanette C - OWCP
File Modified0000-00-00
File Created2021-01-14

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