EEOICPA Benefits Education Survey

We are conducting this Benefits Education Survey to gain insight into the education gaps and resource needs for our local community of former atomic workers. Our goal with this survey is to assess what needs are not being met and use the data to improve our resources surrounding the EEOICPA/White Card benefits for atomic workers locally and nationwide.

Your participation in this survey will allow you the opportunity to use your voice to help other atomic retirees who either may not know about the benefits available to them through the EEOICPA, who are struggling through the benefits process, or who need help learning how to utilize their white card benefits.

Please note: Nuclear Care Partners will not share or sell any personal information shared in the course of this survey.

Use Your Voice to
Help other Atomic Retirees
by participating in our
EEOICPA Benefits Education Survey

How are you completing this survey?(Required)
- With my Community Outreach Manager
- By myself
Community Outreach Manager's Name
How did you hear about this survey?(Required)
- Direct Mailing
- Newspaper
- Digital Ad
- Social Media
- Email
- Friend/Family
- Other
Please specify
Qualifying questions
Did you work at an atomic/DOE site or facility or uranium mine?(Required)
- Yes
- No
Thank you for your interest in this Benefits Education Study. At this time, this study is exclusively for former atomic workers. Thank you!
Have you been diagnosed with cancer or a chronic illness such as COPD, kidney disease, lung disease, or asbestosis that may be linked to your work exposure? (Not an injury)(Required)

Yes

No
Select the type of diagnosis:(Required)
Cancer
Respiratory Disease
Neurological Disorder
Kidney Issues / Renal Failure
Have you heard about the free health screenings that may be available to you?(Required)

Yes

No
Have you heard about the benefits under the EEOICPA?(Required)

Yes

No
Contact Information
We’re collecting this information to ensure we receive accurate data as a part of this study.
Name(Required)
First Last
Address(Required)
Street Address Address Line 2 City State ZIP Code
Phone(Required)
Email(Required)
Age Range(Required)

Under 50

50-60

61-70

71-80

81-90

91+
Gender(Required)

Male

Female
Work History Information
What facility / atomic site / uranium mine did you work at?(Required)
If multiple, please list all.
When did you work there?(Required)
1950-1960
1960-1970
1970-1980
1980-1990
1990-2000
2000-2010
2010-2020
What was your job type / title when you worked in the atomic industry?(Required)
Were you or are you currently a member of a union?(Required)

Yes

No
Which union?
EEOICPA Benefits Education Questions
How did you find out about the EEOICPA & the benefits available through this program?(Required)

The Department of Labor (DOL)

My current provider

My employer at the atomic site

A Filing Agency (Authorized Representative, Attorney, etc.)

A friend or family member

Other
Please specify
Do you have your DOL White Medical Benefits Card?(Required)

Yes

No

In the process of filing

Filed, but denied
Who helped you get your DOL white card?(Required)

The Department of Labor (DOL) - ie. Resource Center or Workers Engagement Center

An Authorized Representative

My current provider

I did it myself

Other
Please specify
How long did it take you to get your card?(Required)

Less than 6 months

6 months - 1 year

1- 2 years

Over 2 years
On a scale of 1-10, how easy was it to get your white card?(Required)
1 being very easy and 10 being extremely difficult.
How long have you had your white card?(Required)

Less than 1 year

1-2 years

2-3 years

3-4 years

4-5 years

Over 5 years
What do you use your white card for?(Required)
Check all that apply.
In-home care services
Doctors office visits
Medical treatments & consultations
Inpatient and outpatient hospital charges (including emergency room visits)
Diagnostic laboratory and radiological testing
Durable medical equipment ie. wheelchairs, walkers, etc.
Medications prescribed by a physician
Reimbursement for out of town travel to the doctor, hospital, clinic, and other medical facilities
Reimbursement for out-of-pocket medical expenses for approved illness
Who is your current provider?(Required)
Which doctor do you see for your approved condition?(Required)
Please list your doctor’s name.
Does your doctor understand the EEOICPA?(Required)

Yes

No
When you have questions about using your white card, who do you call first?(Required)

Current in-home care provider

My physician

My medical benefits examiner

The Department of Labor

Look it up myself

Other
Please specify
What does this entity (answered in the previous question) help you manage with your benefits?(Required)
Check all that apply
How to access benefits / where to use your white card
Impairment ratings
Durable medical equipment
Consequential illnesses / adding them to your card
Pharmacy coverage
Medication management
Billing
Reimbursement for medical expenses
How to navigate the CNSI online portal
What would you like more education on regarding your benefits?(Required)
Check all that apply
How to access benefits / where to use your white card
Impairment ratings
Durable medical equipment
Consequential illnesses / adding them to your card
Pharmacy coverage
Medication management
Billing
Reimbursement for medical expenses
How to navigate the CNSI online portal
Do you currently have someone who assists you with your health in your home?(Required)

Yes

No
If yes, select all that apply:
Nurse
CNA/HHA
Family member
Did your family member receive initial & ongoing training? Are they properly supported?

Yes

No
Do you have any questions or concerns about your benefits that haven’t been addressed?
(Optional)
Consent(Required)
I agree to the privacy policy.
I consent that the information I have entered is correct and acknowledge that Nuclear Care Partners will be using the information I provide to improve the resources and education surrounding the EEOICPA/White Card benefits for atomic workers locally and nationwide.
Thank you for taking the time completing this survey. In return for helping us with this study, we’d like to present you with this pin as a token of our gratitude. *Please allow 4-6 weeks for delivery.
Email
This field is for validation purposes and should be left unchanged.

EEOICPA Benefits Education Survey

Please note: Nuclear Care Partners will not share or sell any personal information shared in the course of this survey.

Use Your Voice to Help other Atomic Retirees by participating in our EEOICPA Benefits Education Survey

Qualifying questions

Contact Information

Work History Information

EEOICPA Benefits Education Questions

Use Your Voice to
Help other Atomic Retirees
by participating in our
EEOICPA Benefits Education Survey