You may qualify for benefits 


Name *
Name
Phone (Your number will be used only be to provide information on benefits) *
Phone (Your number will be used only be to provide information on benefits)
My health has been affected because of my work exposure
Are you one of the following: Nuclear Industry, Uranium Industry, or Coal Industry Worker
I am a former Dept of Energy employee or subcontracted worker

A representative will contact you shortly to discuss whether you may qualify for benefits under the EEOICPA Federal Program.    Thank you.