EE-9 Letter to Claimant

U.S. DEPARTMENT OF LABOR

Office of Workers’ Compensation Programs
Division of Energy Employees Occupational
Illness Compensation
DOL DEEOIC Central Mail Room
P.O. Box 8306
London, KY 40742-8306

Employee:
Case ID Number:
Dear
This letter is in regard to your claim for compensation under the Energy Employees Occupational
Illness Compensation Program Act of 2000, as amended.
We are currently in the process of determining your eligibility for benefits. Our next step in this
process will be to calculate the probability of causation for the diagnosed cancer(s). The calculation
of probability is based on many factors, such as the length of exposure and proximity to radiological
sources, the type of safety protection worn, the type of cancer(s) diagnosed, etc.
Another factor that must be included in the calculation for skin cancer, or a secondary cancer for
which skin cancer is a likely primary cancer, is the race or ethnic identification of the employee.
This information must be entered into the computer program that we are required to use to
determine the probability of causation.
Attached to this letter is an enclosure that must be completed in order for the claim to proceed.
Please fill out the enclosure fully and return it by mail at:
U.S. Department
OWCP/DEEOIC
OWCP/DEEOI
P.O. Box 8306
London, KY 40742-8306
40742 8306
Iff you prefer, you may scan and upload your completed form via the Energy Document Portal at
https://eclaimant.dol.gov. If you choose to complete your form online via EDP, mailing the form is
not necessary.
y We ask that the enclosure be returned within thirtyy ((30)) days
y so as to avoid any
y delay
in the claims adjudication
j
pprocess. Without this completed
p
enclosure, a determination concerning
your entitlement to monetary benefits cannot be issued.

If you have a disability (a substantially limiting physical or mental impairment), please contact our office for
information about the kinds of help available, such as communication assistance (alternate formats or sign language
interpretation), accommodations and modification.

EE-9
July 2024

OMB Control No: 1240-0002
Expiration Date: XX/XX/20XX
Page 1

If you have any questions or concerns, please contact the District Office at

.

Sincerely,

Enclosure: EN-9
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you are hereby notified
that: (1) The Energy Employees Occupational Illness Compensation Program Act (42 USC 7384 et
seq.) (EEOICPA) is administered by the Office of Workers’ Compensation Programs of the U.S.
Department of Labor, which receives and maintains personal information on claimants and their
immediate families. (2) Information received will be used to determine eligibility for, and the
amount of, benefits payable under EEOICPA, and may be verified through computer matches or
other appropriate means. (3) Information may be disclosed to physicians and other health care
providers for use in providing treatment, performing evaluations for the Office of Workers’
Compensation Programs, and for other purposes related to the medical management of the claim.
(4)Failure to disclose all requested information may delay the processing of the claim or the
payment of benefits, or may result in an unfavorable decision.
PUBLIC BURDEN STATEMENT
According to the Paperwork Reduction Act of 1995, no persons are required to respond to the
information collections on this form unless it displays a valid OMB control number. Public
reporting burden for this collection of information is estimated to average 5 minutes per response,
including time for reviewing instructions, searching existing data sources, gathering the data
needed, and completing and reviewing the collection of information. The obligation to respond to
this collection is required to obtain EEOICPA benefits (20 CFR 30.213). Send comments regarding
the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, send them to the U.S. Department of Labor, Office of Workers’
Compensation Programs, Room S3524, 200 Constitution Avenue N.W., Washington, D.C. 20210,
and reference OMB Control No. 1240-0002 and Form EE/EN-9. Do not submit the completed
form to this address.
EE-9
Page 2

Employee:

Case ID Number:

For claims involving radiogenic skin cancer, racial or ethnic identification is incorporated into the
calculation of probability of causation. It is a required element of the program. In order to proceed
with a determination of causation, please mark the box that best matches the racial or ethnic
identification of the employee named above:
American Indian or Alaska Native
Asian, or Native Hawaiian or Other Pacific Islander
Black or African American
Hispanic or Latino
White or Caucasian
Any person who knowingly makes any false statement, concealment of fact, misrepresentation, or
commits any other act of fraud to obtain compensation as provided under EEOICPA or who
knowingly accepts compensation to which that person is not entitled is subject to civil or
administrative remedies as well as felony criminal prosecution and may, under appropriate criminal
provisions, be punished by a fine or imprisonment or both. I certify that the information provided is
accurate and true.
Print Name: _______________________________________________
Signature: _______________________________________________
Date:

____________________

Return Form EN-9 to:

U.S. Department of Labor
OWCP/DEEOIC
P.O. Box 8306
London, KY 40742-8306
Or upload the form via the EDP portal at
https://eclaimant.dol.gov

EN-9
July 2024