Decertification Letter and Appeal Notification for a Health Condition

World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 233094

Information Collection (IC) Details

View Information Collection (IC)

Decertification Letter and Appeal Notification for a Health Condition
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 88.21

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Decertification Letter and Appeal Notification - Health Condition App QQ Decertification Letter_Denial and Decert_Exp.docx No   Paper Only

Health Health Care Services

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

5 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 5 0 5 0 0 0
Annual IC Time Burden (Hours) 8 0 8 0 0 0
Annual IC Cost Burden (Dollars) 135 0 135 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy