Chapter3-0800Exhibit10

SAMPLE Overpayment final decision - WAIVER GRANTED (FUll or Partial) BASED ON VIOLATE EQUITY AND GOOD CONSCIENCE

Employee:

EEOICPA Case ID:

EEOICPA Claim ID:

Claimant Name

Address

Dear {Claimant Name}:

This is the final decision in reference to the overpayment of benefits in the amount of {$ } in your {Part B and/or E} claim under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA or Act). A {full or partial} waiver recovery of the overpayment in your claim is hereby granted.

{Provide explanation of how overpayment occurred.}

On {date}, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) sent you a letter informing you of the overpayment, with a finding that you were without fault in creating the overpayment. The letter also informed you that when a without fault finding is made, the overpaid claimant is still required to repay that money, but may request a waiver under certain financial circumstances. You requested a waiver of recovery of the overpayment.

The EEOICPA Federal Procedure Manual at Chapter 3-0800.10.b states that an overpayment waiver may be granted if recovery would violate equity and good conscience. This means that (1) recovery will cause the claimant to suffer severe financial hardship and meets the required criteria, or (2) the claimant has relinquished a valuable right or changed position for the worse.

To support your waiver request, you stated that {insert claimant’s reason for requesting a waiver}, and submitted the required documentation.

{Describe documents submitted that meet the criteria

for the waiver}

The DEEOIC has reviewed the documents and statements provided, and finds that you meet the criteria for a waiver. Accordingly, the DEEOIC grants a {full or partial} waiver of recovery of the overpayment in the amount of {$ } in the Part {B and/or E} claim filed by {Claimant’s name}.

{If full waiver is granted insert the following

closing paragraph}

This matter is closed and no further action will be taken. If you have any questions about this letter, you may contact this office at {Analyst’s phone number} or 202-693-0081.

Sincerely,

{Name}

Unit Chief for Policy,

Regulations and Procedures

DEEOIC

– or –

{If partial waiver granted, explain further collection actions to be taken and rights as noted below, and include Notice for check payment.}

You must return the remaining overpaid compensation of {$ }. As of the date of this decision, interest on this debt began accruing at the current U.S. Treasury note rate of { %} annually. If you wish to repay the overpayment at this time and avoid the payment of interest, please send your full payment immediately. If you cannot pay the full amount at this time, you may also request to enter into a repayment agreement to make monthly installment payments.

This debt will become delinquent if your payment is not received or you do not request to enter into a repayment agreement within 30 days of the date of this letter. It is important to note that delinquent debts will be referred to the U.S. Department of Treasury for recovery. This referral is authorized under the Debt Collection Act, which also authorizes the assessment of interest, administrative costs, and penalties on delinquent debts. Treasury may utilize various measures to collect the debt, including administrative wage garnishment, offset of payments from federal programs such as income tax refunds, and referral of debts to private collection agencies and the credit bureaus. The information that will be provided to a credit bureau includes your name, address, social security number, the amount, status, history of the debt, and the program under which the debt arose (Energy Employees Occupational Illness Compensation Program).

Certain rights are provided to you with respect to the referral of your debt to Treasury or to credit bureaus. If you think that the determination regarding the debt is in error, you may request further information as noted below. Send your request to this office at DOL DEEOIC Central Mail Room, PO Box 8306, London, KY 40742-8306.

• You may request copies of your records about this debt.

• You may request a review of our determination about the amount of your debt, its past-due status, and its legal enforceability. To exercise this right, you must state your request in writing, state your reason(s) for challenging our determinations, and sign your statement. If you believe that any information of record concerning your debt is not accurate, timely, relevant, or complete, you must provide information or documentation to support your belief.

To pay the overpayment in full, send your payment in the amount of {$ } within 30 days of the date of this letter. Make your check or money order payable to “U.S. Dept. of Labor, OWCP/DEEOIC”, notate the case ID, and indicate that it is for an overpayment. Send the payment to:

US DEPARTMENT OF LABOR

DEEOIC

P.O. Box 77247

Washington, DC 20013

If you wish to set up a repayment agreement or have any questions about this letter, please contact this office at {Analyst’s phone number} or 202-693-0081.

Sincerely,

{Name}

Unit Chief for Policy,

Regulations and Procedures

DEEOIC

Notice to Customers Making Payment by Check

When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment.