Information Collection

World Trade Center Health Program Pentagon/Shanksville Responder Application for Enrollment

IC 270339 under ICR 202502-0920-001 · OMB 0920-0891.

Documents and Forms

Document Name Document Type
Form 0920-0891 World Trade Center Health Program Pentagon/Shanksville Responder Application for Enrollment Form and Instruction
0920-0891 WTCHP - Application for Enrollment: Pentagon/Shanksville pent-shank-draft enrollment form.pdf Form and Instruction
0920-0891 WTCHP - Application for Enrollment: Pentagon/Shanksville pent-shank-draft enrollment form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	World Trade Center Health Program Pentagon/Shanksville Responder Application for Enrollment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0891	WTCHP - Application for Enrollment: Pentagon/Shanksville Responder	pent-shank-draft enrollment form.pdf	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 742	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-742	742
Annual IC Time Burden (Hours)	-371	371
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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