88.5 World Trade Center Health Program Responder App (Other than FDNY)

World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 198305

Information Collection (IC) Details

View Information Collection (IC)

88.5 World Trade Center Health Program Responder App (Other than FDNY)
 
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
Form and Instruction 88.5 World Trade Center Health Program Responder App (Other than FDNY) Appendix D Revised Eligibility Form for Responders Non FDNY 20110623.doc No No Printable Only
Form and Instruction none Eligibility Other than FDNY Appendix D (other than FDNY) - Copy.docx No   Paper 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

2,979 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 2,979 0 0 0 0 2,979
Annual IC Time Burden (Hours) 1,490 0 0 0 0 1,490
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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