OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

FDNY Responder Eligibility Application

IC 214323 under ICR 202502-0920-001 · OMB 0920-0891.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

FDNY Responder Eligibility Application
 
No Modified
 
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 FDNY Responder Eligibility Application App C FDNYResponderEligibility.docx Yes Yes Fillable Fileable
Form n/a Screen shots of Web interface for electronic reporting option App L Web Screen Shots.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0891 WTCHP FDNY Responder Application 10FEB2025 App A-WTCHP FDNY Responder.pdf N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0891 WTCHP FDNY Responder Application 19FEB2025 App A-WTCHP FDNY Responder_FINAL.pdf N/A Yes Yes Fillable Fileable

Health Health Care Services

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

140 0
   
Individuals or Households
 
   50 %

  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 140 0 0 0 140 0
Annual IC Time Burden (Hours) 70 0 0 0 70 0
Annual IC Cost Burden (Dollars) 1,701 0 0 0 1,701 0

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