Petition for the Addition of a Health Condition (previously approved under 0920-0929)

World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 233098

Information Collection (IC) Details

View Information Collection (IC)

Petition for the Addition of a Health Condition (previously approved under 0920-0929)
 
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 and Instruction n/a Petition for the addition of health conditions App NN Petition for Addition of a New WTC Condition.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

60 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 60 0 60 0 0 0
Annual IC Time Burden (Hours) 60 0 60 0 0 0
Annual IC Cost Burden (Dollars) 2,160 0 2,160 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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