Currently Identified Responders and Currently Identified Survivors

World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 200508

Information Collection (IC) Details

View Information Collection (IC)

Currently Identified Responders and Currently Identified Survivors
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 12 Eligibility and Qualification for WTC Health Program Appendis B Eligibility and Qualification 20110623.doc Yes No Paper Only

Health Health Care Services

 

290 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 290 0 0 0 0 290
Annual IC Time Burden (Hours) 48 0 0 0 0 48
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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