From the Radiation Exposure Compensation Program (RECP) Uranium Mine Employee Claim Form, U.S. Department of Justice, Civil Division, 2021
Part I: YOU, the person filling out this form
If you are a member of an Indian Tribe, please check the relevant box below:
Print your census number here:
If you are a member of an Indian Tribe, fill out page 17.
If YOU are the person who became ill you may proceed to Part 3 and are NOT required to fill out Part 2