Get Dol Ee-2 2016-2025

The DoL EE-2 form is essential for submitting a survivor's claim for benefits under the Energy Employees Occupational Illness Compensation Program Act. This guide provides clear, step-by-step instructions to help users complete the form efficiently.

Follow the steps to successfully complete the DoL EE-2 form online.

1. Press the 'Get Form' button to obtain the form and open it in an editor.
2. Begin filling out the Deceased Employee Information section. Include the name, sex, Social Security number, date of birth, and date of death. If applicable, indicate if an autopsy was performed and provide the medical facility's name.
3. Complete the Survivor Information section by providing your name, sex, Social Security number, date of birth, relationship to the deceased employee, and your contact details.
4. Identify the diagnosed condition(s) being claimed as work-related in Item 14. Check the appropriate box and list specific diagnoses as required. Include the date of diagnosis in Item 15.
5. Provide information regarding any lawsuits or state workers' compensation claims related to the exposure of toxic substances in the awards and other information section.
6. List any other potential survivors in Item 22, including their names, relationships to the deceased employee, addresses, and phone numbers.
7. Review the Survivor Declaration and sign and date the bottom of page 2. Ensure that all information is accurate and complete.
8. Once the form is filled out, save changes, download, print, or share the form as necessary. Be sure to attach all additional documents required for submission.

Complete your DoL EE-2 form online today to ensure timely processing of your claim.