Request a RECA Claim Form

This information is being collected in accordance with 5 U.S.C. § 301 and 44 U.S.C. § 3101 and with the purposes and uses described in the Privacy Act system of records notice for the Department of Justice Correspondence Management Systems, published at 66 Fed. Reg. 29,992 (June 4, 2001).  Providing this information is strictly voluntary.

To request a Radiation Exposure Compensation Act (RECA) Claim Form, please provide the following information: