Date: Case ID Number:

Employee Name:

Claimant Name::

Representative Name

Address

City, State, Zip Code

Dear [Representative]:

According to our records, you have been designated as the authorized representative in the above case. As the authorized representative, you have the ability to receive correspondence, submit additional evidence, argue factual or legal issues and exercise appeal rights pertaining to the above claim. The authorized representative does not have signature authority on behalf of the claimant on Form EN-20.

As the authorized representative of [claimant name], any correspondence from the Division of Energy Employees Occupational Illness Compensation (DEEOIC) will be directed to you in this capacity. If the correspondence indicates a response is warranted or additional information is required, it is expected that you will make the necessary arrangements with [claimant name].

Representative Fees. A representative may charge the claimant a fee for costs associated with his/her activities regarding the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). The claimant is solely responsible for paying any fee or other costs associated with the actions of a representative. The DEEOIC will not reimburse the claimant, nor is it liable for the amount of any fee and other costs relating to an agreement between a claimant and a representative.

Permissible Charges. Under the regulations implementing 42 U.S.C. § 7385g, a representative is permitted to charge an appropriate fee for services related to a claim before DEEOIC. The maximum allowable percentage of a payment of lump-sum compensation that can be collected as a fee is as follows:

(1) 2% for the filing of an initial claim with DEEOIC, provided that the representative was retained prior to the filing of the initial claim; plus

(2) 10% of the difference between the lump-sum payment made to the claimant and the amount proposed in the recommended decision with respect to objections to a recommended decision.

Conflict of Interest Policy. As an authorized representative of a claimant under the EEOICPA, you are prohibited from having private, non-representational direct financial interests, other than your fee for serving as a representative, in regard to your client’s claim with DEEOIC. Because the “role” of an authorized representative is so important, DEEOIC will consider you to have a conflict of interest if you could directly benefit financially from your client’s EEOICPA claim due to something other than your statutorily limited fee for representing your client in connection with his or her EEOICPA claim. For example, you will be considered to have a conflict of interest if, in addition to being your client’s authorized representative, you are also being paid by DEEOIC, directly or indirectly, as a provider of authorized medical services to your client. Because there is an obvious conflict of interest that will arise in this sort of situation, DEEOIC will not recognize you as an authorized representative should this occur, and will inform the claimant of the need to designate another person as his or her authorized representative who does not have such a conflict. If you are in a position to directly benefit financially from your client’s EEOICPA claim, you are required to notify DEEOIC and withdraw as representative.

Please feel free to contact the District Office or Final Adjudication Branch, if you have any questions or concerns. Our telephone number is 000-000-0000.

Sincerely,

Printed Name

Title

District Office/Final Adjudication Branch

cc: Claimant