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Screen shots of Web interface for electronic reporting o
World Trade Center Health Program Enrollment, Appeals & Reimbursement
App L Web Screen Shots
FDNY Responder Eligibility Application
OMB: 0920-0891
OMB.report
HHS/CDC
OMB 0920-0891
ICR 201703-0920-004
IC 214323
Screen shots of Web interface for electronic reporting o
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-0891 can be found here:
2024-09-11 - Revision of a currently approved collection
2024-02-13 - No material or nonsubstantive change to a currently approved collection
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Appendix L
Web Based Application Screen Shots (samples)
File Type
application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author
Breyer, Laurie I. (CDC/NIOSH/EID)
File Modified
0000-00-00
File Created
2021-01-20
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