Clinic Selection Postcard for new general responders in NY/NJ to select a clinic

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

OMB: 0920-0891

IC ID: 218096

Information Collection (IC) Details

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Clinic Selection Postcard for new general responders in NY/NJ to select a clinic
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form n/a Clinic Selection Postcard App R Clinic Selection Postcard.pdf No   Paper Only

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

3,830 0
   
Individuals or Households
 
   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 3,830 0 0 0 0 3,830
Annual IC Time Burden (Hours) 958 0 0 0 0 958
Annual IC Cost Burden (Dollars) 17,427 0 0 0 0 17,427

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