WTC Health Program General HIPAA Authorization to Third Parties

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

OMB: 0920-0891

IC ID: 251023

Information Collection (IC) Details

View Information Collection (IC)

WTC Health Program General HIPAA Authorization to Third Parties
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0891 WTC Health Program HIPAA Authorization - Third Parties App P WTCHP General HIPAA Authorization to Third Parties DRAFT.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-0891 General HIPAA Authorization for Disclosures to Third Parties App-P-WTCHP-General-HIPAA-Authorization-to-Third-Parties-updated2024.pdf N/A Yes Yes Fillable Fileable

Health Consumer Health and Safety

09-20-0147 Occupational Health Epidemiologic Studies and EEOICPA Program Records and WTC Health Program Records  76 FR 34706

30 0
   
Individuals or Households
 
   100 %

  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 30 0 0 0 0 30
Annual IC Time Burden (Hours) 8 0 0 0 0 8
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy