Information Collection

Youth Research Cohort Registration HIPAA Authorization

IC 273995 under ICR 202502-0920-001 · OMB 0920-0891.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0891 Youth Research Cohort Registration HIPAA Authorization	Form and Instruction
Form 0920-0891 WTCHP Youth Research Cohort HIPAA Authorization Form_10FEB2025 Youth Research Cohort Registration HIPAA Authorization	Form and Instruction
0920-0891 WTCHP Youth Research Cohort HIPAA Authorization Form_10F App Q1-YRC HIPAA Authorization Form 2025.pdf	Form and Instruction
0920-0891 WTCHP Youth Research Cohort HIPAA Authorization Form_10F App Q1-YRC HIPAA Authorization Form 2025.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0891			N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Occupational Health Epidemiological Studies and EEOICPA Progr09-20-0147 Records and WTC Health Program Records, HHS/CDC/NIOSH

FR Citation: 76 FR 34706

Number of Respondents: 6,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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