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Petitioner Submission Format other than Form B 42 CFR 83.9
EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)
Attachment D2 example of petition without Form B
Petitioner Submission Format other than Form B 42 CFR 83.9
OMB: 0920-0639
OMB.report
HHS/CDC
OMB 0920-0639
ICR 201909-0920-003
IC 180184
Petitioner Submission Format other than Form B 42 CFR 83.9
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-0639 can be found here:
2022-12-21 - Extension without change of a currently approved collection
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2013-04-30
File Created
2013-04-30
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