Appeals regarding Eligibility Denial

World Trade Center Health Program Enrollment & Appeals - Pentagon & Shanksville, PA Responders

OMB: 0920-0962

IC ID: 206320

Documents and Forms
Information Collection (IC) Details

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Appeals regarding Eligibility Denial
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Document Appendix C Appeal to Eligibility Denial.docx Yes No Fillable Printable

Health Health Care Services

Occupational Health epidemiological Studies and EEOICPA Program Records and WTC Probram Records  76 FR 31212

4 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 4 4 0 0 0 0
Annual IC Time Burden (Hours) 2 2 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Denial Letter Sample Denial Letter C-1 - Eligibility.docx 03/31/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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