Pentagon / Shanksville Responder

[NIOSH] World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 214325

Information Collection (IC) Details

View Information Collection (IC)

Pentagon / Shanksville Responder
 
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 Pentagon / Shanksville Responder Eligibility Application App G Pentagon-Shanksville Application.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0891 WTCHP Pentagon_Shanksville Application_10FEB2025 App E-WTCHP Pentagon Shanksville App for Enrollment.pdf N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0891 WTCHP Pentagon_Shanksville Application 19FEB2025 App E-WTCHP Pentagon Shanksville Enrollment_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

742 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 742 0 500 0 242 0
Annual IC Time Burden (Hours) 371 0 250 0 121 0
Annual IC Cost Burden (Dollars) 6,752 0 4,550 0 2,202 0

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