Claim for Consequential Illness Benefits Under the Energy Employees Occupational Illness Compensation Program Act

OMB 1240-0063

Latest Forms, Documents, and Supporting Material

Document Name
Form EE-1 Claim for Consequential Illness Benefits under the Employees Occupational Illness Compensation Program Act Form and Instruction
1240-0NEW_Supporting Statement_DEEOIC Consequential Illness Form (EE1-A)_FINAL.docx Supporting Statement A
Claim for Consequential Illness Benefits under the Employees Occupational Illness Compensation Program Act Form and Instruction