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How to fill out the Ee 2 online
Filling out the Ee 2 form is an essential process for claiming survivor benefits under the Energy Employees Occupational Illness Compensation Program Act. This guide provides a step-by-step approach to help users complete the form accurately and efficiently.
Follow the steps to complete the Ee 2 form online.
- Press the ‘Get Form’ button to acquire the form and open it in your online editor.
- Begin filling out the 'Deceased Employee Information' section. Enter the full name, sex, social security number, date of birth, and date of death for the deceased employee clearly.
- Indicate whether an autopsy was performed on the deceased by selecting 'Yes', 'No', or 'Don’t know'. If 'Yes', provide the name of the medical facility.
- Complete the 'Survivor Information' section. Fill in your full name, sex, social security number, date of birth, address, relationship to the deceased employee, and telephone numbers.
- Identify any diagnosed conditions that you are claiming as work-related in Item 14. Choose the correct diagnosis and provide additional details if necessary.
- List the date of diagnosis for the claimed conditions in Item 15, specifying the day, month, and year.
- In the 'Awards and Other Information' section, respond to the questions about previous lawsuits or workers' compensation claims by marking the 'Yes' or 'No' options and providing necessary documentation if applicable.
- Complete Item 22 by listing other potential survivors and providing their names, relationships to the deceased, addresses, and phone numbers.
- Finalize the form by reading the 'Survivor Declaration'. Provide your signature, along with the date, affirming the information is true.
- Once completed, save your changes. You may choose to download, print, or share the form as needed.
Ensure you complete your claims process successfully by filling out the Ee 2 form online today.
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