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E-mail This PageDOL Form EEOICP EE-4
| Agency: | OWCP-EEOICP |
| Title: | EEOICP EE-4, Employment History Affidavit for Claim Under Energy Employees Occupational Illness Compensation Program Act |
| Form Description: | EEOICP EE-4, Employment History Affidavit for Claim Under Energy Employees Occupational Illness Compensation Program Act: Applicants use this form to submit an Employment History Affadavit for a claim under the EEOICPA. |
| OMB Control Number: | 1240-0002 |
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