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November 4, 2008    DOL Home > ESA > WHD > DEEOIC > Claims Forms   

Office of Workers' Compensation Programs (OWCP)

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OWCP Administers disability compensation programs that provide benefits for certain workers or dependants who experience work-related injury or illness.
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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 one of two options: the “Print Form and Mail” option or the “Electronic Completion/Submit” 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.

District Office Locations

esco Electronic Completion/Submit Option esco

Forms noted with esco on the list of forms below, may be completed and submitted to DEEOIC electronically. To begin, simply click on the desired form to apply for your digital signature (please read “Important Note” below). After receiving your digital signature you may complete the form on-line using your computer keyboard and then submit the form electronically by clicking on the SUBMIT button at the top of the form. After doing so, you will receive a message indicating that the form was sent to DEEOIC. (We recommend that you also print the form prior to submitting it so that you have a hard copy for your records.)

Important Note: Before you can submit your first DEEOIC form electronically you must apply for a digital signature and receive authorization to use it. This process may take approximately 5-10 business days to complete. You will be asked if you want to apply for a digital signature when you first open a DEEOIC form. Alternatively you can click here to apply for a digital signature from IdenTrust Inc. now. This will cost you nothing and you only have to do this one time. You will receive confirmation of your authorized digital signature via U.S. Mail. You may use the same digital signature on all DEEOIC forms that you wish to submit electronically.

If you have questions or need assistance completing and submitting these forms electronically, you can send DEEOIC a question via e-mail by clicking DEEOIC-FormsAssistance. DEEOIC will respond to your question via e-mail.



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