Pharmacy - Outpatient Prescription Pharmaceuticals

World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 218099

Information Collection (IC) Details

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Pharmacy - Outpatient Prescription Pharmaceuticals
 
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 none Pharmacy Appendix HH Outpatient Prescription Pharmaceuticals.docx Yes Yes Fillable Fileable

Health Health Care Services

09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program Records and WTC Health Program Records, HHS/CDC/NIOSH  76 FR 34706

150 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 39,150 0 39,150 0 0 0
Annual IC Time Burden (Hours) 653 0 653 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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