88.9 World Trade Center Health Program Survivor Eligibility Application

World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 198306

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88.9 World Trade Center Health Program Survivor Eligibility Application
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Appendix E Revised Eligibility Form for Survivors 20110624.doc No No Printable Only

Health Health Care Services

09-20-0147 Occupational Health Epidemiological Studies and CCOICPA Program Records, and WTC Program Records HHS/CDC/NIOSH  76 FR 31212

1,560 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,560 0 0 0 0 1,560
Annual IC Time Burden (Hours) 390 0 0 0 0 390
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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