Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act

Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act

What Is Form EE-4?

This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on September 1, 2021 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2021;
  • The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form EE-4 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.

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Download Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act

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  • Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act

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  • Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act, Page 2

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  • Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act, Page 1
  • Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act, Page 2
  • Form EE-4 Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act, Page 3
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