World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB 0920-0891

OMB 0920-0891

The WTC Health Program is a limited healthcare program established by the James Zadroga 9/11 Health and Compensation Act of 2010. The goal of the Program is to provide monitoring and treatment to responders of the 9/11 terrorist attacks at the World Trade Center, Pentagon, and Shanksville, PA, as well as survivors in the New York City Area. The data collected contained within this OMB package are intended solely for determining eligibility and treatment.

The latest form for World Trade Center Health Program Enrollment, Appeals & Reimbursement expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material
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OMB Details

FDNY Responder Eligibility Application

Federal Enterprise Architecture: Health - Health Care Services

Form n/aFDNY Responder Eligibility ApplicationFillable FileableForm and instruction
Form n/aScreen shots of Web interface for electronic reporting optionFillable FileableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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