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This version of the form is not currently in use and is provided for reference only. Download this version of
Form EE-3
for the current year.
Form EE-3 Employment History for a Claim Under the Energy Employees Occupational Illness Compensation Program Act
What Is Form EE-3?
This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on November 1, 2015 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form EE-3?
A: Form EE-3 is a document used to provide employment history for a claim under the Energy Employees Occupational IllnessCompensation Program Act.
Q: Who uses Form EE-3?
A: Form EE-3 is used by individuals who are making a claim under the Energy Employees Occupational Illness Compensation Program Act.
Q: What information is required in Form EE-3?
A: Form EE-3 requires information about the individual's employment history, including company names, job titles, and dates of employment.
Q: Is Form EE-3 specific to the United States or Canada?
A: Form EE-3 is specific to the United States.
Q: What is the Energy Employees Occupational Illness Compensation Program Act?
A: The Energy Employees Occupational Illness Compensation Program Act provides compensation and benefits to individuals who have developed illnesses due to exposure to toxic substances while working in the energy industry.
Form Details:
- Released on November 1, 2015;
- The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form EE-3 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.
Download Form EE-3 Employment History for a Claim Under the Energy Employees Occupational Illness Compensation Program Act
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