Responder Appeals to Eligibility Denial

World Trade Center Enrollment & Appeals - Pentagon & Shanksville

OMB: 0920-1001

IC ID: 209335

Documents and Forms
Information Collection (IC) Details

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Responder Appeals to Eligibility Denial
 
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
Other-Letter Appendix C Appeal to Eligibility Denial.docx No No Printable Only

Health Health Care Services

09-20-0147 Occupational Health Epidemiological Studies, EEOICPA Program Records and WTC Health Program Records, HHS/CDC/NIOSH  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 0 4 0 0 0
Annual IC Time Burden (Hours) 2 0 2 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Eligibility Denial Letter Denial Letter C-1 - Eligibility.docx 11/07/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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