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Federal forms, ICRs, and supporting documents

Information Collection Request

World Trade Center Health Program Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center (WTC) Health Program

ICR 201201-0920-011 · OMB 0920-0929 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center (WTC) Health Program Form and Instruction New Available
Attachment A_Zadroga Act.pdf Supplementary Document Uploaded 2012-01-27 Available
Attachment D_NIOSH final rule 42 cfr 88.17 for OMB PRA review 1.17.12.docx Supplementary Document Uploaded 2012-01-27 Available
SuppStatemen World Trade Center Health Program New Condition Petitions 1.17.12.docx Supporting Statement A Uploaded 2012-01-27 Available
IC Document Collections
IC IDCollectionTypeStatusForm
200945 Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center (WTC) Health Program Form and Instruction New
ICR Details
0920-0929 201201-0920-011
Historical Active
HHS/CDC
World Trade Center Health Program Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center (WTC) Health Program
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/18/2012
Retrieve Notice of Action (NOA) 01/30/2012
Approved consistent with the provisions of the associated final rule (RIN 0920-AA45).
  Inventory as of this Action Requested Previously Approved
04/30/2015 36 Months From Approved
100 0 0
4,000 0 0
0 0 0
Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 amended the Public Health Service Act (PHS Act) to establish the World Trade Center (WTC) Health Program. Sections 3311, 3312, and 3321 of Title XXXIII of the PHS Act require that the WTC Program Administrator develop regulations to implement portions of the WTC Health Program established within the Department of Health and Human Services (HHS). The WTC Health Program is administered by the Director of the National Institute for Occupational Safety and Health (NIOSH), within the Centers for Disease Control and Prevention (CDC). The Zadroga Act requires that the Program accept petitions from interested parties to add a health condition to the list of WTC-related health conditions in 42 CFR ?88.1. The information provided with this form and supporting documentation will be used by the WTC Program Administrator to consider the disposition of a petitioned-for health condition. Disclosure of this information is voluntary.
PL: Pub.L. 111 - 347 3312 Name of Law: James Zadroga 9/11 Health and Compensation Act of 2010
  
None
0920-AA45 Final or interim final rulemaking 76 FR 38938 07/01/2011
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 100 0 0 100 0 0
Annual Time Burden (Hours) 4,000 0 0 4,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is new ICR.
$34,480
No
Yes
No
No
No
Uncollected
Petunia Gissendaner 4046390164
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/30/2012