Forms - Energy Employees Advocacy Group

These are the various forms you may need to submit to us or the Department of Labor in order to file a claim or be represented. We can work with you to determine which forms are needed, and how to fill them out.

Authorized Representative Form

The form needed for us to be assigned your Authorized Representative

Client Agreement

Our Agreement when working with you

Workers Claim for Benefits (EE-1)

The basic EEOICPA application form for employees

Survivors Claim for Benefits (EE-2)

The basic EEOICPA application form for survivors of employees

Employment History (EE-3)

Department of Energy work history form for employees or survivors

Employee History Affidavit for claim (EE-4)

This form is used when work history cannot be verified through records, but an individual (such as a colleague or coworker) can be found with knowledge of the employees work history