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Appeals regarding Eligibility Denial
World Trade Center Health Program Enrollment & Appeals - Pentagon & Shanksville, PA Responders
OMB: 0920-0962
IC ID: 206320
OMB.report
HHS/CDC
OMB 0920-0962
ICR 201304-0920-001
IC 206320
( )
Documents and Forms
Document Name
Document Type
Appendix C Appeal to Eligibility Denial.docx
Other-Document
Denial Letter C-1 - Eligibility.docx
Denial Letter Sample
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Appeals regarding Eligibility Denial
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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
Other-Document
Appendix C Appeal to Eligibility Denial.docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
Occupational Health epidemiological Studies and EEOICPA Program Records and WTC Probram Records
FR Citation:
76 FR 31212
Number of Respondents:
4
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
4
4
0
0
0
0
Annual IC Time Burden (Hours)
2
2
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Denial Letter Sample
Denial Letter C-1 - Eligibility.docx
03/31/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.