SEC0D~50 

Special Exposure Cohort Petition U.S. Department of Health and Human Services 

under the Energy Employees Occupational Centers for Disease Control and Prevention Illness Compensation Program Act National Institute for Occupational Safety and Health -

Special Exposure Cohort Petition - Form B 0MB Number: 0920-0639 Expires: 10/31/2019 

Page 1 of 7 

· Use of this form is voluntary; .Failure to.use this form will .not result in. · ... . the denial of any right, ·benefit, or privilege to which you may be entitled.'. 

General Instructions on Completing this Form (complete instructions are available in· a separate packet): 

Except for signatures, p_lease PRINT all information clearly and neatly on the form. 

Please read each of Parts A - G in this form and complete the sections appropriate to you. If there is more 

than one petitioner, then each petitioner should complete those sections of Parts A - C of the form that apply 

to them. Additional copies of the first two pages of this form are provided at the end of the form for this 

purpose. A maximum of three petitioners is allowed. 

If '.r'.OU need more space to provide additional information, use the continuation page provided at the end of 

the form and attach the completed continuation page(s) to Form B. 

For Further Information: If you have questions about the use of this form, please call the following NIOSH 

toll-free phone number and request to speak to someone in the Division of Compensation Analysis and 

Support about an SEC petition: 1-877-222-8570. 

I Start at D .. 

If you t------· Start at C 

are: I Start at B ~ - .. 

I Start at A I 

A. Representative Information Complete Part A if you are authorized by an Energy Employee or 

Survivor(s) to petition on behalf of a class. 

A.1 Are you a contact person for an organization? D Yes (Go to A.2) D No (Go to A.3) 

A.2 Organization Information: 

Name of Orga!'ization 

Position of Contact Person 

A.3 Name.of Petition Representative: 

Mr./Mrs./Ms. First Name Middle Initial Last Name 

A.4 · Address of Petition Representative: 

Street Apt# P.O. Box 

City State Zip Code 

A.5 Telephone Number of Petition Representative: ( ____ ------------'---

A.6 Email Address of Petition Representative: 

A.7 
' • 

Special Exposure Cohort Petition· 

under the Energy Employees Occupational 

Illness Compensation Program Act 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

Special Exposure Cohort Petition - Form B 0MB Number: 0920·0639 Expires: 10/31/2019 

Pa e 2 of 7 . ' . . . . 

B.1 Name of Survivor: 

Mr./Mrs./Ms. First Name Middle Initial 

B.2 Address of Survivor: 

Street 

City State 

B.3 Telephone Number of Survivor: 

B.4 Email Address of Survivor: 

B.5 Relationship to Energy Employee: D Spouse 

OGrandparent 

,... . . Go to Part C. 

Last Name 

Apt# P.O. Box 

Zip Code 

D Son/Daughter 

OGrandchild ... .: ·: .·. 

OParent 

C. Energy Employee Information Complete Part C UNLESS you are a labor organization. 

C.1 Name of Energy Employee: 

1-1rst Name Middle Initial Last Name 

C.2 Former Name of Energy Employee (e.g., maiden name/legal name change/other): 

Mr./Mrs./Ms. First Name Middle Initial 

C.3 Address of Energy Employee (if living): 

I 

Su'l:.cl 

City State 

C.4 Telephone Number of Energy Employee: L 

C.5 Email Address· of Energy Employee: 

C.6 Employment Information Related to Petitlor: 

C.6a Energy Employee Number (if known): __ 

C.6b Dates of Employment: l O I ( 1 eo 

L 

C.6c Employer Name: ._ :::L__ 

C.6d Work Site Location: 

C.6e Supervisor's Name: _ 

Last Name 

Apt# P.O. Box 

Zip Code 

IEnd 3 J ao 1.3> . 

" 

~ •. J . •. :, 

I 
----

Special Exposure Cohort Petition 

under the Energy Employees Occupational 

lllne~s Compensation Progr~m Act 

D.1 Labor Organization Information: 

Name of Organization 

Position of Contact Person 

D.2 Name of Petition Representative: 

Mr./Mrs./Ms. · First Name 

D..3 · Address of Petition Representative: · 

Street 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational ·Safety and Health 

0MB Number: 0920-0639 

. . . 

Middle Initial Last Name 

Apt# P.O. Box 

City State Zip Code 

D.4 Telephone Number of Petition Representativ_e: ( ____ ). ____________ _ 

Q.5 

D.6 

D.7 

Email Address of Petition Representative: 

Period during which labor organization represented energy employees covered by this petition 

(please attach documentation): 

Start End 

Identity of other labor organizations that may represent or have represented this class 

of energy employees (if known): 

Go to Part E. 
Special Exposure Cohort Petition 

under the Energy Employees Occupational 

Illness Compensation Program Act 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

Special Exposure Cohort Petition - Form B 0MB Number: 0920-0639 Expires: 10/31/2019 

Page4 of7 

E. Proposed Definition of Energy Employee Class Covered by Petition Complete Part E. 

E.1 Name of DOE or AWE Facility: __ _,'Y.__-_\..::.......:'L:c...=.. ______________ _ 

E.2. Locations at the Facility relevant to this petition: 

Ml '{ .... \'.)..°l>~ ~"t:~ U~"'' u-.~ ~AS'~~~ OL fq,\J •, ~+c.,e\ 

E.3 List job titles and/or Job duties of energy employees Included in the class. In addition, you can 

list by name any individuals other than petitioners identified on this form who you believe 

should be included in this class: 

A\\ woak.~~ 

E.4 Employment Dates relevant to this petition: 

Start Ja)\~ -I t,eo 

Start 

. Start 

End 1):r:cz:~t)J;(\... 

End 

End 

E.5 Is the petition based on one or more unmonitored, unrecorded, or inadequately monitored or 

recorded exposure incidents?: 

If yes, provide the date(s) of the incident(s) and a complete description (attach additional pages as 

necessary): 

Go to Part f; 
Special Exposure Cohort Petition 

under the Energy Employees Occupational 

Illness Compensation Program Act 

Special Exposure Cohort Petition - Form B 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

0MB Number: 0920-0639 Expires: 10/31/2019 

Page 5 of7 

F. Basis for Proposing that Records and Information are Inadequate for Individual Dose 

[ Reconstruction Complete Part F. 

Complete at least one of the following entries in this section by checking the appropriate box and providing 

the required information related to the selection. You are not required to complete more than one entry. 

F.1 I/We have attached either documents or statements provided by affidavit that indicate that 

radiation exposures and radiation doses potentially incurred by members of the proposed class, 

that relate to this petition, were not monitored, either through personal monitoring or through area 

monitoring. 

(Attach documents and/or affi_davits to the back of the petition form.) 

Describe as completely as possible, to the extent it might be unclear, how the attached 

documentation and/or affidavit(s) indicate that potential radiation exposures were not monitored. 

F.2 . I/ We have attached either documents or statements provided by affidavit that indicate that. 1 

radiation monitoring records for members of the proposed class have been lost, falsified, or 

destroyed; or that there is no information regarding monitoring, source, source term, or process 

from the site where the energy employees worked. 

(Attach documents and/or affidavits to the back of the petition form.) 

Describe as completely as possible, to the extent it might be unclear, how the attached 

documentation and/or affidavit(s) indicate that radiation monitoring records for members of the 

proposed class have been lost, altered ille!lallv. or destroyr _. 

I . ' 

.. Part F is continued on the followin a e. 
) 

Special Exposure Cohort Petition 

under the Energy Employees Occupational 

Illness Compensation Program Act 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

Special Exposure Cohort Petition - Form B 0MB Number: 0920-0639 Expires: 10/31/2019 

Paae 6 of 7 

· F .3 I/We have attached a report from a health physicist or other individual with expertise in 

radiation dose reconstruction documenting the limitations of existing DOE or AWE records on 

radiation exposures at the facility, as relevant to the petition. The report specifies the basis for 

believing these documented limitations might prevent the completion of dose reconstructions for 

members of the class under 42 CFR Part 82 and related NIOSH technical implementation · 

guidelines. · 

(Attach report to the back of the petition form.) 

F.4 ~ I/We have attached a scientific or technical report, issued by a government agency of the 

Executive Branch of Government or the General Accounting Office, the Nuclear Regulatory 

Commission, or the Defense Nuclear Facilities Safety Board, or published in a peer-reviewed 

journal, that identifies dosimetry and related information that are unavailable (due to either a lack 

of monitoring or the destruction or loss of records) for estimating the radiation doses of energy 

employees covered by the petition. 

(Attach report to the back of the petition form.) 

.Go to Part G: 

G. Signature of Person(s) Submitting this Petition Complete Part G. 

All Petitioners should sign and date the petition. A maximum of three persons may sign the petition. 

Signature 

Signature 

Signature 

Notice: 

Date 

Date 

Date 

Any person who knowingly makes any false statement, misrepresentation, concealment of 

fact or any other act of fraud to obtain compensation as provided under EEOICPA or who 

knowingly accepts compensation to which that person is not entitled is subject to civil or · 

administrative remedies as well as felony criminal prosecution and may, under appropriate 

criminal provisions, be punished by a fine or imprisonment or both. I affirm that the information 

provided on this form is accurate and true. 

Send this form to: SEC Petition 

Division of Compensation Analysis and Support 

NIOSH 

1090 Tusculum Ave, MS-C-47 

Cincinnati, OH 45226 

If there are additional petitioners, they mustcompl~te ttie Appendix Forms for additional petltlon.ers. 

· The Appendlx·f~,rms c1re located at the end of this ~ocu~ent. 
Special Exposure Cohort Petiti9n 

under the Energy Employees Occupational 

Illness Compensation Program Act 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

Special Exposure Cohort Petition - Form B 

0MB Number: 0920-0639 Expires: 1013112019 

Paae 7 of 7 

Public Burden Statement 

Public reporting burden for this collection of information is estimat~d to average 5 hours per response, 

including time for reviewing instructions, gathering the information needed, and completing the form. If you 

have any·comments regarding the burden ,estimate or any other aspect of this collection of information, 

including suggestions for reducing this burden, send them to CDC Reports Clearance Officer, 1600 Clifton 

Road, MS-E-11, Atlanta GA, 30333; ATTN: PRA 0920-0639. Do not send the completed petition form to this 

address. Completed petitions are to be submitted to NIOSH at the address provided in these instructions. 

Persons are not required ·to respond to the information collected on this form unless it displays.a currently 

valid 0MB number. 

Priv.acy Act Advisement 

In accordance with the Privacy Act of 1974, as amended (5 U.S.C. § 552a), you are hereby notified of the 

following: 

The Energy Employees Occupational Illness Compensation Program Act (42 U.S.C. §§ 7384-7385) 

(EEO IC PA) authorizes the President to designate additional classes of employees to be included in the 

Special Exposure Cohort (SEC). EEOICPA authorizes HHS to implement i\s responsibilities with the 

assistance of the National Institute for Occupational Safety (NIOSH), an Institute of the Centers for Disease 

Control and Prevention. Information obtained by NIOSH in connection with petitions for including additional 

classes of employees in the SEC will be used to evaluate the petition and report findings to the Advisory 

Board on Radiation and Worker Health and HHS. 

Records containing identifiable information become part of an existing NIOSH system of records under the 

Privacy Act, 09-20-147 "Occupational Health Epidemiological Studies and EEOICPA Program Records and 

WTC Health Program Records, HHS/CDCINIOSH." These records are treated in a confidential manner, 

unless otherwise.compelled by law. Disclosures that NIOSH may need to make for the processing of your 

petition or other purposes are listed below. 

NIOSH may need to disclose personal identifying information to: (a) the Department of Energy, other federal 

agencies, other government or private entities and to private sector employers to permit these entities to 

retrieve records required by NIOSH; (b) identified witnesses as designated by NIOSH so that these 

individuals can provide information to assist with the evaluation of SEC petitions; (c) contractors assisting 

NIOSH; (d) collaborating researchers, under certain limited circumstances to conduct further investigations; 

(e) Federal, state and local agencies for law enforcement purposes; and (f) a Member of Congress or a 

Congressional staff member in response to a verified inquiry. 

This notice applies to all forms and informational requests that you may receive from NIOSH in connection 

with the evaluation of an SEC petition. 

Use of the NIOSH petition forms (A and B) is voluntary but your provision of information required by these 

forms is mandatory for the consideration of a petition, as specified under 42 CFR Part 83. Petitions that fail to 

provide required information may not be considered by HHS. 
I 

This page intentionally left blank. 

\ 
Special Exposure Cohort Petition U.S. Department of Health and Human Services 

under the Energy Employees Occupational Centers for Disease Control and Prevention 

Illness Compensation Program Act National Institute for Occupational Safety and Health 

Special Exposure Cohort Petition - Form B 0MB Number:.0920-0639 Expires: 10/31/2019 

Aooendix Petitioner 2 

Use of this form Is voluntary. Failure to use this form will not result In· 

the denial of any right, benefit, or privilege to which you may be entitled. 

Use this Appendix for Petitioner 2. 

This appendix form is to be used as needed. Petitioner 2, or his or her representative, should complete the 

sections applicable to him or her. 

Refer to the General Instructions on completing petitioner information for Parts A, B, or C. 

If JlOU need more si::1ace to i::1rovide additional information, use.the continuation page provided at the end of 

the form and attach the completed continuation page(s) to Form B. 

Except for signatures, please PRINT all information clearly and neatly on the form. 

D An Energy Employee (current or former), Start at C /fyou DA Survivor (of a former Energy Employee). Start at B are: 

D A Representative (of a current or former Energy EIT\ployee or Survivor); Start at A 

A. Representative Information Complete Part A if you are authorized by an Energy Employee or 

Survivor(s) to petition on behalf of a class. 

A.1 Are you a contact person for an organization? D Yes (Go to A.2) 0 No (Go to A.3) 

A.2 Organization Information: 

Name of Organization 

Position of Contact Person 

A.3 Name of Petition Representative: 

Mr./Mrs./Ms. First Name Middle Initial - Last Name 

A.4 · Address of Petition Representative: 

Street Apt# P.0 .. Box 

City State Zip Code 

A.5 Telephone Number of Petition Representative: (\.. ___ .-1-------------

A.6 Email Address of Petition Representative: 

A.7 O Check the box at left to indicate you have-attached to the back of this form written authorization to 

petition by the survivor(s) or energy employee(s) indicated in Parts B or C of this form. An 

authorization form for this purpose is provided. 

If 
Special Exposure Cohort Petition 

under the Energy Employees Occupational 

Illness Compensation Program Act 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

0MB Number: 0920-0639 

. . 

8.1 Name of Survivor:· 

Mr./Mrs./Ms. First Name Middle Initial 

8.2 Address of Survivor: 

Street 

City State 

8.3 Telephone Number of Survivor: 

8.4 Email Address of Survivor: · 

8.5 Relationship to Energy Employee: tJ Spouse 

DGrandparent 

. Go to Part C .. 

C. Energy Employee Information Complete Part C. 

C.1 Name of Energy Employee: 

Mr./Mrs./Ms. First Name Middle Initial 

Last Name 

Apt# P.O. Box 

Zip Code 

D Son/Daughter 

DGrandchild 

DParent 

Last Name 

C.2 Former Name of Energy Employee (e.g., maiden name/legal name change/other): 

Mr./Mrs./Ms. First Name · Middle Initial Last Name 

C.3 Address of Energy Employee (if living): 

Street Apt# P.O. Box 

City State Zip Code 

C.4 Telephone Number of Energy Employee: 

C.5 Email Address of Energy Employee: 

C.6 Employment Information Related to Petition: 

C.6a Energy Employee Number (if known): 

C.6b Dates of Employment: Start End 

C.6c Employer Name: 

C.6d Work Site Location: 

C.6e Supervisor's Name: 
Special Exposure Cohort Petition U.S. Department of Health and Human Services 

under the Energy Employees Occupational Centers for Disease Control and Prevention 

Illness Compensation Program Act National Institute for Occupational Safety and Health 

Special Exposure Cohort Petition - Form B 0MB Number: 0920-0639 Expires: 10/31/2019 

Aooendix -. Petitioner 3 

Use of this.form is.ve>luntary. Fallure.to use this form wllLnot result In , 

the denial of.any.right, benefit; or privilege to which you may be entitled .. 

Use this Appendix for Petitioner 3. 

This appendix form is to be used as needed. Petitioner 3, or his or her representative, should complete the 

sections applicable to him or her. 

Refer to the General Instructions on completing petitioner information for Parts A, B, or C. 

If you need more space to provide additional information, use the continuation page provided at the end of 

the form and attach the completed continuation page(s) to Form B. 

Except for signatures. please PRINT all information clearly and neatly on th~ form. 

D An Energy Employee (current or former), . Start at C 

If you DA Survivor (of a former Energy Employee), Start at B 

are: 

DA Representative (of a current or former Energy Employee); Start at A' 

A. Representative Information Complete Part A if you are authorized by an Energy Employee or 

Survivor(s) to petition on behalf of a class. 

A.1 Are you a contact person for an organization? D Yes (Go to A.2) D No (Go to A.3) 

A.2 Organization Information: 

Name of Organization 

Position of Contact Person 

A.3 Name of Petition Representative: 

Mr./Mrs./Ms. First Name Middle Initial Last Name 

A.4 Address of Petition Representative: 

A.5 

A.6 

A.7 

Street. Apt# P.O. Box 

City State Zip Cod~ 

Telephone Number of Petition Representative: .._ ___ ·-------------

Email Address of Petition Representative: 

ci Check the box at left to indicate you have attached to the back of this form written authorization to· 

petition by the survivor(s) or energy employee(s) indicated in Parts B or C of this form. An 

authorization form for this purpose is provided. 
I. 

I:, 

I 

Special Exposure Cohort Petition 

under the Energy Employees Occupational 

Illness Compensation Program A~t · 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention . 

National Institute for Occupational Safety and Health 

0MB Number: 0920-0639 

B.1 Name of Survivor: 

Mr./Mrs./Ms. First Name Middle 1.nitial Last Name 

B.2 Address of Survivor: 

Street Apt# P.O. Box· 

City State Zip Code 

B.3 Telephone Number of Survivor: 

. B.4 Email Address of Survivor: 

8.5 Relationship to Energy Employee: D Spouse DSon/Daughter OParent 

DGrandparent DGrandchild 

Go to Part C. 

C. Energy Employee Information Complete Part C. 

C.1 Name of Energy Employee: 

Mr./Mrs./Ms. First Name Middle Initial Last Name 

C.2 Former Name of Energy Employee (e.g., maiden name/legal name change/other): 

Mr./Mrs./Ms. First Name Middle Initial .Last Name 

C.3 Address of Energy Employee (if living): 

Street Apt# P.O. Box 

City State Zip Code 

· C.4 Telephone Number of Energy Employee: 

C.5 Email Address of Energy Employee: 

C.6 Employment Information Related to Petition: 

C.6a Energy Employee Number (if known): --------------------

C.6b Dates of Employment: Start --------- End 

C.6c Employer Name: 

C.6d Work Site Location: ---------------------------

C.6e Supervisor's Name: -------.C.....-------------------
Special Exposure Cohort Petition 

under the Energy Employees Occupational 

Illness Compensation Program Act 

Special Exposure Cohort Petition - Form B 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

0MB Number: 0920-0639 Expires: 10/31/2019 

A . nd·x Contln r Pa 

Continuation Page Photocopy and complete as necessary. 

Attach to· Form B if necessa . 
Special Exposure Cohort Petition 

under the Energy Employees Occupational 

Illness Compensation Program Act 

Petitioner Authorization Form 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

0MB Number: 0920-0639 Expires: 10/31/2019 

Page 1 of2 

Use of this form is voluntary. Failure to use this form wlll not result in 

the denial of any right, benefit, or privilege to which you may be entitled. 

Instructions: 

If you wish to petition HHS to consider adding a class of energy employees to the Special Exposure Cohort 

and you are NOT either a member of that class, a survivor of a member of that class, or a labor organization 

representing or having represented members of that class, then 42 CFR Part 83, Section 83. 7(c) requires 

that you obtain written authorization. You can obtain such authorization from either an energy employee who 

is a member of the class .or a survivor of such an employee. You may use this form to obtain such 

authorization and submit the completed form to NIOSH with the related petition. Please print legibly. 

For Further Information: If you have questions about these instructions, please call the following 

NIOSH toll-free phone number and request to speak to someone In the Division of Compensation 

Analysis and Support about an SEC petition: 1-877-222-8670. 

Authorization for Individual or Entity to Petition HHS on Behalf of a Class of Energy Employees for 

Addition to the Special Exposure Coho1t 

I, 

Name of Class Member or survivor 

Street Address of Class Member or Survivor Apt.# P.O. Box 

- - Cny, .:>tan~. Zip Code of Class Memcer or ~urvivor 

do hereby authorize: 

Name of Petitioner 

Address of Petitioner Apt.# P.O. Box 

City, State and Zip Code of Petitioner 

to petition the Department of Health and Human Services on behalf of a class of energy 

employees that Include 

- ·- _ _ _ ~\\ \ D:a&2£ at- V-)1--

Name or (.;lass Member (energy employee, not the employee's survivor) 

for the addition of the class to the Special Exposure Cohort, under the Energy Employee's 

Occupational Illness Compensation Program Act (42 U.S.C. §§ 7384-7386). 

In providing this authorization, I ntcognize that the petitioner named above will have all the rights 

of a petitioner as proviJle~ for under 42 CFR Part 83. · 

S,~11QLUl'I. "'' >JIQ"'"' IVl'l.1111,1'1.I .... ~u,1/ivor. 

1b\-X)( Io 

Date 
Special Exposure Cohort Petition 

under the Energy Employees Occupational 

Illness Compensation Program Act 

Petitioner Authorization Form 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

0MB Number: 0920-0639 

Public Bu.rden Statement 

Expires: 10/31/2019 

Paao2of2 

Public reporting burden for this collection of information is estimated to average 3 minutes per response, 

including time for reviewing instructions, gathering the information needed, and completing the form. If you 

have any comments regarding the burden estimate or any other aspect of this collection of information, 

including suggestions for reducing this burden, send them to CDC Reports Clearance Officer, 1600 Clifton 

Road, MS-E-11, Atlanta GA, 30333;· A TIN:PRA 0920-0639. Do not send the completed petition form to this 

·address.Completed petitions are to be submitted.to NIOSH at the address provided in these instructions. 

Persons are not required to respond to the information collected on this form unless it displays a currently 

valid 0MB number. 

Privacy Act Advisement 

In accordance with the Privacy Act of 1974, as amended (5 u.s.c. § 552a), you are hereby notified of the 

following: 

The Energy Employees Occupational Illness Compensation Program Act (42 U.S.C. §§ 7384-7385) 

(EEOICPA) authorizes the President to designate additional classes of employees to be included in the . 

Special Exposure Cohort (SEC). EEOICPA authorizes HHS to implement its responsibilities with the 

assistance of the National Institute for Occupational Safety (NIOSH), an Institute· of the Centers for Disease 

Control and Prevention. Information obtained by NIOSH in connection with petitions for including.additional 

classes of employees in the SEC will be used to evaluate the petition and report findings to the Advisory 

Board on Radiation and Worker Health and HHS .. 

Records containing Identifiable information become part of an existing NIOSH system of records under the 

Privacy Act, 09-20-147 °0ccupational Health Epidemiological Studies and EEOICPA Program Records and 

WTC Health Program Records, HHS/CDC/NIOSH. a These records are treated in a confidential manner, 

unless otherwise compelled by law. Disclosures that NIOSH may need to' make for the processing of your 

petition or other purposes are listed below. 

NIOSH may need to disclose personal identifying information to: (a) the Department of Energy, other federal 

agencies, Qther government or private entities and to private sector employers to permit these enti~ies to 

retrieve records required by NIOSH; (b) identified witnesses as designated by NIOSH so that these 

individuals can provide information to assist with the evaluation of SEC petitions; (c) contractors assisting 

NIOSH; (d) collaborating researchers, under certain limited circumstances to conduct further investigations; 

(e) Federal, state and local agencies for law enforcement purposes; and (f) a Member of Congress or a 

Congressional staff member in response to a verified inquiry. 

This notice applies to all forms and informational requests that you may receive from NIOSH in connection 

with the evaluation of an SEC petition. 

use of this form Is voluntary. Failure to use this form will not result In the denial of any right, benefit, or 

privilege to which you may be entitled. 
*STI.GOV / Technical Report: Y-12 Uranium Exposure Study 

Y-12 Uranium Exposure Study 

Full Record 

TECHNICAL 

REPORT: 

-~~ 

-~ 

~~IMGl) 

DOI: 10.2172/10166 , 

SAVE / SHARE: 

Export Metadata v 

Save to My Library 

f 1?' G• 

liia . Q 

https://www.osti.gov/biblio/10166 

Other Related Research 

Abstract 

Following the recent restart of operations at the Y-12 Plant, the 

Radiological Control Organization {RCO) observed that the 

enriched uranium exposures appeared to involve insoluble rather 

than soluble uranium that presumably characterized most earlier 

Y-12 operations. These observations necessitated changes in 

the bioassay program, particularly the need for routine fecal 

sampling. In addition, it was not ~easonable to interpret the 

bioassay data using metabolic parameter values established . 

during earlier Y-12 operations. Thus. the recent urinary and fecal 

bioassay data were inte~preted using the default guidance in 

Publication 54 of the International Commission on Radiological 

Protection {ICRP); that is, inhalation of Class Y uranium with an 

activity median aerodynamic diameter {AMAD) of 1 {micro}m. 

Faced with apparently new workplace conditions, these actions 

10/20/18, 12:11 PM 

Page 1 of 3 
https://www.osti.gov/biblio/10166 

were appropriate and ensured a cautionary approach to worker. 

protection. As additional bioassay data were accumulated, it 

became apparent that the data were not consistent with 

Publication 54. Therefore, this study was undertaken to examine 

the situation. \r 

Authors: Eckerman, K.F.; Kerr, G."D. 

Publication Date: 1999-08-05 

Research Org.: Oak Ridge National Lab., TN (US) 

Sponsoring Org.: 

OSTI Identifier: 

USDOE Office o( Energy Research (ER) (US) 

10166 

Report Number(s): ORNL/TM-1999/114 

TRN:AH200125%%359 

DOE Contract Number: ACOS-960~22464 

Resource Type: Technical Report 

Resource Relation: Other lnforr~ation: PBD: 5 Aug 1999 

Country of Publication: United States 

Language: English 

Subject: 60 APPLIED LIFE SCIENCES; AERODYNAMICS; 

BIOASSAY; ENRICHED URANIUM; 

INHALATION; RADIATION PROTECTION; 

SAMPLING; URANIUM; Y-12 PLANT 

Citation Formats 

MLA APA Chicago Bibtex 

10/20/18, 12:11 PM 

Page 2 of 3 · 
Eckerman, K.F., and Kerr, G.D. Y-12 Uranium Exposure 

Study. United States: N. p., 1999. Web. 

doi:10.2172/10166. · 

Office of Scientific and 

Technical Information 

Copy to clipboard 

.· a Website Policies / Important Links Q Contact Us f G• 

https://www.osti.gov/biblio/10166 10/201'8, 12:11 PM 

Page 3 of 3 
October 18, 2018 

SEC Petition 

NIOSH DCAS 

1090 Tusculum Avenue, 

Cincinnati, Ohio 45226 

Re: Special Exposure Cohort Petition for Y-12 plant 

Attached is a petition for workers at the Y-12 plant to be included in the Special Exposure Cohort (SEC). 

The petition asks that all workers in all Y-12 buildings where uranium was processed or fabricated 

between January 1, 1980 through December 31, 2000 be covered. The evidence shows that, 

Y-12 did not monitor for internal dose prior to 1990. 

The bottom of the attached occupational radiation report states, "a - Monitoring riot required; b -In 

accordance with regulations, Internal Dose and Total Dose were not calculated prior to 1989" 

Additionally, pages 50 and 51 of NIQSH's document asserts that, 

https://www.cdc.gov/niosh/ocas/pdfs/tbd/y125-r3.pdf 

"Thus, the presence of fecal sample results in an individual's monitoring records is a strong indicator 

that the worker was exposed to insoluble uranium compounds. " 

NIOSH's assumption is incorrect shows that routine fecal sampling was not done before 1999. 

The first page of "Y-12 Uranium Exposure Study" dated August S, 1999, 

https:ljwww.ornl.gov/sites/default/files/TM1999-114.pdf states, 

"Following the recent restart of operations at the Y-12 Plant, the Radiological Control Organization 

(RCO) observed that the enriched uranium exposures appeared to involve insoluble rather than 

soluble uranium that presumably characterized most earlier Y-12 operations. These observations 

necessitated changes in the bioassay program, particularly the need for routine fecal sampling." 

Page 3 of this DOE memo dated July 15, 1999 stiows the examples of deficiencies in worker monitoring 

programs across the DOE complex. 

htt ps :lj energy .gov /si tes/prod/files/hss/Enforcenient%20a nd%200versight/E n fo rcem en t/ arch ives/gu ida 

nce/990715bioassa·y.pdf · 
1. Annual reports to workers documenting their exposures to radiation incomplete. 

2. Repeated failures to perform in vivo bioassays as required. 

3: Failure to perform special, follow-up bioassays in a timely manner. 

4. Radiological worker restrictions not implement~d in a timely manner. 

5. Failure to perform termination bioassays and, subsequently, failure to issue reports of terminated 

worker exposures. 

6. Collection of routine bioassay samples incomplete. 

7. Analysis of bioassay samples not performed for all radionuclides to which wor~ers were exposed. 

8. Workers enrolled in incorrect routine bioassay program. 

9. Job-specific Radiation Work Permit (RWP) requir~d bioassay samples not collected and processed. 

10. Routine and special bioassay samples not collected and processed as required. 

11. Dose assessments and subsequent dose assignment for workers with intakes of radioactive material 

not completed. 

12. Bioassay program not consistently implemented across a contractor site. 

13. Decision Levels in use did not appropriately reflect current quantitative capability of the site 

laboratory. 

14. Inconsistent application of bioassay requirements for similar work activities. 

15. Untimely performance of worker dose assessments. 

16. Untimely radioanalytiqil processing of bioassay samples. 

17. Internal dqse assessments not accurate. 

18. IDEP procedure reviews and subsequent revisions not performed. 

19. Bioassay sample submission not verified as required. 

Sincerely, 

-

,· 
PRIVACY ACT INFORMATION 

Name: Badge: SSNi ·----

External Dose 

(rem) 

I Internal Dose Total Dose 

Year Lens of Eve Extremities s-.auow .Deeu (rem) (rem) 

1980 a a 0.720 0.040 a b 

1981 a a 0.060 0.000 a b 

1982 a a o.sso 0.000 b b 

1983 a a 1.660 0.160 b b . 

1984 a a 0.110 0.030 b b 

1985 a 0 0.250 0.000 a b 

1986 a a 0.000 0.000 a b 

1987 D a 0.000 0.000 a b 

1988 D a 0.000 0.000 3 b 

1989 a. Q 0.000 0.000 a 0.000 

1990 a a 0.000 0.000 a 0.000 

1991 a a 0.000 0.000 0.000 0.000 

1992 a a 0.000 0.000 n 0.000 

1993 I a a 0.000 0.000 a 0.000 

1994 a a 0.066 0.000 B 0.000 

1995 Q 8 0.000 - 0.000 0.000 0.000 

1996 a 0 0.069 0.000 0.000 0.000 

1997 Q a 0.340 0.000 0.000 0.000 

1998 a 3 0.236 0.010 0.001 0.011 

1999 n n 0.093 0.012 0.013 0.025 

2000 a a 8 a 0.000 0.000 

II Cumulative Total Dose since 1989 = 0.036 

8 Monitoring not required · 

b 1n accordance w ilh regulations, Internal Dose and Total Dose were not calculated prior to 1989 

PRIVACY,ACT INFORMATION 
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