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This document is used to petition for inclusion in the Special Exposure Cohort under the Energy Employees Occupational Illness Compensation Act. It collects information related to the petitioner,

How to fill out special exposure cohort petition

How to fill out Special Exposure Cohort Petition

1. Obtain the Special Exposure Cohort Petition form from the National Institute for Occupational Safety and Health (NIOSH) website.
2. Gather necessary documentation, including evidence of employment at a covered facility and any relevant health records.
3. Fill out the personal information section, including name, contact information, and details about your employment history.
4. Provide detailed information about the specific exposure to hazardous materials, including dates, locations, and types of exposure.
5. Attach any supporting documents, such as medical records or employment verification, that substantiate your claims.
6. Review the completed application for accuracy and completeness.
7. Submit the petition to NIOSH, ensuring you keep a copy for your records.

Who needs Special Exposure Cohort Petition?

1. Individuals who worked at designated atomic weapons employer sites, beryllium vendors, or uranium miners.
2. Workers exposed to radiation or other hazardous substances during their employment.
3. Those who have suffered or are suffering from health issues potentially related to their exposure at covered facilities.

People Also Ask about

What is special exposure cohort?

The Special Exposure Cohort (SEC) is a uniquely defined category of employees established under The Act. The SEC is comprised of classes of employees who: have at least one of the 22 SEC cancers and. have worked for a specific period of time at one of the SEC Work Sites.

What cancers are covered under EEOICPA?

EEOICPA: The 22 Specified Cancers Leukemia; Primary or secondary cancer of the lungs; Primary or secondary bone cancer; Primary or secondary renal cancer; Primary thyroid cancer; Primary cancer; Primary esophagus cancer; Primary stomach cancer;

What cancers are covered under EEOICPA?

EEOICPA: The 22 Specified Cancers Leukemia; Primary or secondary cancer of the lungs; Primary or secondary bone cancer; Primary or secondary renal cancer; Primary thyroid cancer; Primary cancer; Primary esophagus cancer; Primary stomach cancer;

What is an exposure based cohort?

Cohort studies are observational studies that follow groups of patients with different exposures forward in time and determine outcomes of interest in each exposure group or that investigate the effect of one or more participant characteristics on prognostic outcomes [1].

For pdfFiller’s FAQs

What is Special Exposure Cohort Petition?

The Special Exposure Cohort Petition is a formal request submitted to the Department of Energy or the National Institute for Occupational Safety and Health, seeking inclusion of a group of workers who may have been exposed to radiation or hazardous materials during their employment. This petition allows these workers to receive compensation for health issues related to their exposure.

Who is required to file Special Exposure Cohort Petition?

Any individual or group of workers who believe they were exposed to harmful levels of radiation or toxic substances in the workplace and meet specific eligibility criteria can file a Special Exposure Cohort Petition.

How to fill out Special Exposure Cohort Petition?

To fill out a Special Exposure Cohort Petition, individuals must obtain the petition form from the appropriate agency, provide detailed information about their employment history, including job titles, locations, dates worked, and the nature of exposure, and submit any supporting documentation that can substantiate the claims.

What is the purpose of Special Exposure Cohort Petition?

The purpose of the Special Exposure Cohort Petition is to provide a mechanism for workers to seek recognition of their exposure to hazardous substances or radiation, which may qualify them for compensation and medical benefits due to health issues resulting from that exposure.

What information must be reported on Special Exposure Cohort Petition?

The Special Exposure Cohort Petition must include the names and addresses of the petitioners, details of the worksite, job titles, dates of employment, descriptions of potential exposure to radiation or toxic substances, and any relevant health information of the affected workers.