EEOICPA Forms

Welcome to the EEOICPA Forms page. All of the EEOICPA Forms are shown below and are available for download in PDF format. Please ensure you have Adobe Acrobat Reader installed on your computer. If you do not have Adobe Acrobat Reader installed on your computer, then you can download the most recent version by clicking the “Get Adobe Acrobat Reader” Button:

EEOICPA Forms PDF

Employee’s Claim: Form EE-1

Survivor’s Claim: Form EE-2

Employment History: Form EE-3

Employment History Affidavit: Form EE-4

Medical Requirements: Form EE-7

Physician/Provider Billing Form: OWCP-1500

Reimbursement for out-of-pocket medical expenses: OWCP-915

Uniform Billing Form for Medical Services: OWCP-04

Medical Travel Refund Request: OWCP-957

Direct Deposit Sign-up: Form SF-1199A

RECA Claim Forms PDF

If you are looking for downloadable PDF RECA Claim Forms, please see the section “Claim Forms” on the RECA page.