Division of Energy Employees Occupational Illness Compensation (DEEOIC)
Claims Forms
The Division of Energy Employees Occupational Illness Compensation (DEEOIC) has made a variety of forms available on-line. These forms may be completed and submitted to DEEOIC using the “Print Form and Mail” option.
Note that all the electronic forms listed below are only available in PDF format. In order to view and/or print PDF documents you must have a PDF viewer. It is highly recommended that you have the most current version available on your workstation (click on Adobe Acrobat Reader to download Adobe Reader 6.x). Also, when printing these forms please remember to use the Adobe Acrobat Reader PRINT icon at or near the top of the form and not your browser's print icon.
Print Form and Mail Option
All DEEOIC forms listed below are available on-line to complete, print and submit via U.S. MAIL. Simply click on the appropriate form and decline the option to apply for a digital signature. Then fill in the required information using your computer keyboard and print the form using the Adobe Acrobat Reader PRINT icon. You may hand write any additional information on the printed hard copy. You must sign the form with your hand-written signature. Finally, you must mail the completed form to the appropriate DEEOIC District office.
Mailed claims should be submitted to the District Office that has jurisdiction over the state where the employee last worked for a Department of Energy employer. Click on the link below for a map of District Office jurisdictions. All claims for supplemental benefits from individuals who have received an award from the Department of Justice under Section 5 of the Radiation Exposure Compensation Act (RECA) should be sent to the Denver District Office.
Online Forms
- Employee's Claim: Form EE-1
- Survivor's Claim: Form EE-2
- Employment History: Form EE-3
- Employment History Affidavit: Form EE-4
- Medical Requirements: Form EE-7
- Physician/Provider Billing Form: OWCP-1500
- Reimbursement for out-of-pocket medical expenses: OWCP-915
- Uniform Billing Form for Medical Services: OWCP-04
- Medical Travel Refund Request: OWCP-957
If you have questions or need assistance completing or submitting these forms, you can send DEEOIC a question via e-mail by clicking DEEOIC-FormsAssistance. DEEOIC will respond to your question via e-mail.
