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HIPAA Authorization to Release Information
[NIOSH] World Trade Center Health Program Enrollment, Appeals & Reimbursement
OMB: 0920-0891
IC ID: 233095
OMB.report
HHS/CDC
OMB 0920-0891
ICR 202402-0920-004
IC 233095
( )
Documents and Forms
Document Name
Document Type
HIPAA Authorization to Release Information
Form and Instruction
HIPAA Authorization to Release Information
Form and Instruction
HIPAA Authorization Form to Release Information
App MM WTC HIPAA Form.docx
Form and Instruction
Information Collection (IC) Details
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