Get the free Special Exposure Cohort Petition - Form B - cdc

-- Special Exposure Cohort Petition under the Energy Employees Occupational U*S* Department of Health and Centers for D sease Control and Prevention National Institute for Occupat onal Safety and Health illness Compensatron Act OM5 Number 0920-0639 Expires 05/31/2007 Page I of 7 use of*this form and disclosure of Social Security Number are voluntary. Ailure to. use this fo oi disclose this number will not result in the denial of any right benefit or privilege to which you may be entitled*...

How to fill out special exposure cohort petition

How to fill out Special Exposure Cohort Petition - Form B

1. Download the Special Exposure Cohort Petition - Form B from the official website.
2. Read the instructions carefully before starting to fill out the form.
3. Provide personal information including name, address, and contact details in the designated sections.
4. Detail the circumstances of your exposure to harmful substances, including dates and locations.
5. Include any supporting documentation or evidence that supports your claims.
6. Review the form for any errors or omissions.
7. Sign and date the form where indicated.
8. Submit the completed form according to the guidelines provided, which may include mailing or electronic submission.

Who needs Special Exposure Cohort Petition - Form B?

1. Individuals who have been exposed to specific radioactive materials during their employment.
2. Workers who have developed health issues related to their exposure.
3. Survivors or family members of workers who have passed away from related health conditions.
4. Persons seeking accountability for occupational exposure in covered facilities.

People Also Ask about

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].

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.

For pdfFiller’s FAQs

What is Special Exposure Cohort Petition - Form B?

The Special Exposure Cohort Petition - Form B is a specific form used to petition for inclusion in the Special Exposure Cohort, which allows certain individuals who were exposed to radioactive materials during their employment to receive compensation for their illnesses.

Who is required to file Special Exposure Cohort Petition - Form B?

Individuals who believe they were exposed to radioactive materials during their work at designated facilities and have developed certain specified illnesses may file the Special Exposure Cohort Petition - Form B.

How to fill out Special Exposure Cohort Petition - Form B?

To fill out the Special Exposure Cohort Petition - Form B, obtain the form from the necessary agency, complete the required sections by providing personal details, exposure history, and relevant medical information, and submit it according to the provided instructions.

What is the purpose of Special Exposure Cohort Petition - Form B?

The purpose of the Special Exposure Cohort Petition - Form B is to gather evidence for claims by individuals seeking compensation for health issues related to exposure to radioactive materials, aiming to ensure they receive the necessary support.

What information must be reported on Special Exposure Cohort Petition - Form B?

The information required on Special Exposure Cohort Petition - Form B includes personal identification details, employment history, specific dates and locations of exposure, the types of radioactive materials involved, and medical documentation of the related health issues.