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INSTRUCTIONS for 1199A Form US Department of Labor

INSTRUCTIONS for 1199A Form US Department of Labor

Use a form 1199 template to make your document workflow more streamlined.

Information is 10 minutes per respondent or recordkeeper depending on individual circumstances. PLEASE READ THIS CAREFULLY All information on this form including the individual claim number is required under 31 USC 3322 31 CFR 209 and/or 210. Including the SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS. SIGNATURE DATE GOVERNMENT AGENCY NAME Division of Energy Employees Occupational Illness U.S. Department of Labor OWCP/DEEOIC P. Your social security number is requested to ensure the accurate...
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