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Worker’s Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act

Form ID:

OWCP EE-1

Control ID:

OMB Control No: 1240-0002

Expiration date:

Wed, 31 May 2028 - 23:59

Forms

OWCP EE-1: Worker’s Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act

Note: Please read the instructions on page 2 before filling out this form. Provide all information requested, and sign and date the bottom of page 1. Do not write in the shaded areas.