SF 3881 ACH Vendor/Miscellaneous Payment Enrollment Form

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

OMB: 0920-0962

IC ID: 206323

Information Collection (IC) Details

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SF 3881 ACH Vendor/Miscellaneous Payment Enrollment Form
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SF 3881 ACH Form Appendix D ACH Vendor_Miscellaneous Payment Enrollment Form SF 3881.pdf Yes Yes Fillable Fileable

Health Health Care Services

Occupational Health epidemiological Studies and EEOICPA Program Records and WTC Probram Records  78 FR 31212

5 0
   
Individuals or Households
 
   100 %

  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 5 5 0 0 0 0
Annual IC Time Burden (Hours) 1 1 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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