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Read these instructions carefully before completing the form. Accuracy and thoroughness will aid in the prompt payment of the claim.The PREP Act provides compensation to individuals for serious physical injuries or deaths from pandemic, epidemic, or security countermeasures identified in. (a) Death gratuity authorized. Pursuant to RSA 281-A:26 and New Hampshire Administrative Rule Chapter Lab 515. Claimant's Rights to Direct Deposit. • This form is optional. The employer may not authorize examination or medical or other treatment in any case that OWCP has disallowed. The employer may not authorize examination or medical or other treatment in any case that OWCP has disallowed. Please complete this form for injuries occurring after July 1, 2007.