Responder Denial Ltter and Appeal Notification - Treatment

World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 214336

Information Collection (IC) Details

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Responder Denial Ltter and Appeal Notification - Treatment
 
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 n/a Denial Letter and Appeal Notification for Treatment Authorization App BB Treatment Denial Letter and Appeal Notification.docx No   Paper Only

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

26 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 26 0 0 0 0 26
Annual IC Time Burden (Hours) 39 0 26 0 0 13
Annual IC Cost Burden (Dollars) 702 0 702 0 0 0

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