Example

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service 

 

NIOSH Tracking Number: XXXXX National Institute for Occupational 

 Safety and Health 

 Robert A. Taft Laboratories

 4676 Columbia Parkway

 Cincinnati, OH 45226-1998 

 Phone: (513) 533-XXXX

 Fax: (513) 533-XXXX

 August 23, 2006 

Ms. Jane Doe 

123 Main Avenue 

Town, CO 12345 

Dear Ms. Jane Doe: 

This letter is to provide you with information on the status of the dose reconstruction for the claim 

you filed under the Energy Employees Occupational Illness Compensation Program Act (NIOSH 

Tracking Number XXXXX). 

The National Institute for Occupational Safety and Health’s (NIOSH) Office of Compensation 

Analysis and Support (OCAS) has completed a reconstruction of the radiation dose. Enclosed 

you will find a copy of a Draft NIOSH Report of Dose Reconstruction under the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA). During the next two weeks, we will

attempt to contact you to schedule a convenient date and time for conducting a closing interview 

with you. The purpose of the closing interview is to review the dose reconstruction results and the 

basis on which the results were calculated. This will be the final opportunity during the dose 

reconstruction process for you to provide additional relevant information that may affect the dose 

reconstruction or indicate that you are in the process of obtaining such information. To facilitate 

the scheduling of the interview, you can contact us at the following telephone number 1-800-790-

6728 (1-800-790-ORAU). If, after three weeks from the date of this letter, we have not heard back 

from you regarding a convenient time to schedule the interview, then we will assume that you 

have decided not to participate in the interview. 

We have also enclosed a copy of a form (OCAS-1) that should be signed and returned to us 

within 60 days. In the event that NIOSH prepares a revised draft dose reconstruction report based 

upon any additional information provided by you, then the OCAS-1 form will be due no later than 

60 days from the date you receive the revised draft dose reconstruction report. Your signature on 

this form certifies that you agree with the following statements: 1) you are not aware of any 

additional information that may be relevant to the dose reconstruction; 2) you have reviewed the 

draft dose reconstruction report and agree that it identifies all of the relevant information you 

provided to NIOSH regarding the dose reconstruction; and 3) the dose reconstruction report is 

ready to be forwarded to the Department of Labor (DOL) for a determination regarding your claim. 

Your signature on this form is not an indication that you agree with the decisions NIOSH made 

concerning how to use or not use information you provided for dose reconstruction or that you 

agree with the findings of the NIOSH dose reconstruction. DOL’s Office of Workers’ 

Compensation Programs (OWCP) will notify you of any action that it may take regarding your 

claim, and of any rights you may have to raise objections. You will have an opportunity to raise 

objections to the final NIOSH Dose Reconstruction Report under EEOICPA following your receipt 

of a copy of the recommended decision on your claim from DOL by following the procedures 

described in the notice accompanying the recommended decision. 
Example

Page 2 – Ms. Jane Doe 

Once we receive the signed OCAS-1 form from you, we will send the final copy of the dose 

reconstruction report to the DOL for adjudication of your claim. We will also send you and the 

Department of Energy a copy of the final dose reconstruction report. It is important that you return 

the properly signed OCAS-1 to us within the above-described time frame so that there is no delay 

in the adjudication of your claim. We will not forward the dose reconstruction report to DOL for 

adjudication without receipt of a properly signed OCAS-1. If we do not receive the OCAS-1 within 

the timeframe described above, we may administratively close the dose reconstruction and notify 

DOL of this action. PLEASE USE THE ENCLOSED PRE-ADDRESSED, POSTAGE-PAID 

ENVELOPE TO RETURN THE SIGNED OCAS-1 TO US. 

If you have any additional questions regarding this dose reconstruction report, please contact our 

dose reconstruction contractor, Oak Ridge Associated Universities, toll-free at 1-800-322-0111. 

 Sincerely yours, 

 

 Larry J. Elliott, MSPH, CIH 

 Director 

 Office of Compensation Analysis and Support 

Enclosures 

cc: File XXXXX