Chapter3-0800 Exhibit7

SAMPLE OVERPAYMENT FINAL DECISION – PRELIMINARY AT FAULT DETERMINATION CORRECT

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).

{Provide explanation of how overpayment occurred.}

{Provide explanation of how the overpayment final decision was determined.}

Based on the review of the evidence of record, DEEOIC finds that you did not provide sufficient evidence to reverse the preliminary overpayment determination. Accordingly, the final determination in this case is that you were at fault in causing the overpayment, and that you must return the {$ }.

In addition, as of the date of this decision, interest on this debt began accruing at the current U.S. Department of 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. You may also request to enter into a repayment agreement to make monthly installment payments. If we do not receive your payment or request to enter into a repayment agreement within 30 days of the date of this letter, this will be a delinquent debt.

It is important to note that delinquent debts will be referred to the Department of the 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. Various measures may be utilized 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 credit bureaus. The information that will be provided to a credit bureau includes your name, address, social security number, the amount, status, and 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 the Department of Treasury or credit bureaus. If you think that the determination regarding the debt is in error, you may request further information as noted below, and send your request to: 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, you should send your payment in the amount of {$ } within 30 days. Make your check or money order payable to “U.S. Dept. of Labor, OWCP/DEEOIC.” Please notate the case ID on the check or money order and indicate that it is for an overpayment refund. Send the payment to: US Department of Labor, DEEOIC, PO Box 77247, Washington, DC 20013.

If you cannot repay the full amount at this time and would like to enter into a written repayment agreement, you should contact this office to make arrangements for installment payments. The Overpayment Recovery Questionnaire and supporting financial documentation will be used in setting up the repayment agreement.

If you have any questions about this letter or wish to set up an installment repayment plan, you may contact me at {phone number} or 202-693-0081.

Sincerely,

{PA name}

Policy Unit

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.