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WTC Health Program HIPAA Authorization for Deceased Individuals
[NIOSH] World Trade Center Health Program Enrollment, Appeals & Reimbursement
OMB: 0920-0891
IC ID: 251018
OMB.report
HHS/CDC
OMB 0920-0891
ICR 202402-0920-004
IC 251018
( )
Documents and Forms
Document Name
Document Type
Form 0920-0891
WTC Health Program HIPAA Authorization for Deceased Individuals
Form and Instruction
Form 0920-0891
WTC Health Program HIPAA Authorization for Deceased Individuals
Form and Instruction
0920-0891 WTC Health Program HIPAA Authorization - Deceased Individuals
App O WTCHP HIPAA Authorization for Deceased Individuals DRAFT.docx
Form and Instruction
0920-0891 HIPAA Authorization for Disclosures Regarding Deceased Individuals
App-O-WTCHP-HIPAA-Authorization-for-Deceased-Individuals-updated2024.pdf
Form and Instruction
Information Collection (IC) Details
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