OMB.report

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 201406-0920-015 · 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
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 Removed Repair queued
Mini-supporting statement (change request).docx Justification for No Material/Nonsubstantive Change Uploaded 2014-06-25 Available
Attachment A_Zadroga Act.pdf Supplementary Document Uploaded 2012-01-27 Repair queued
Attachment D_NIOSH final rule 42 cfr 88.17 for OMB PRA review 1.17.12.docx Supplementary Document Uploaded 2012-01-27 Repair queued
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
212076 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
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 Removed
ICR Details
0920-0929 201406-0920-015
Historical Active 201201-0920-011
HHS/CDC 0920-092914AGW
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
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 07/07/2014
Retrieve Notice of Action (NOA) 06/26/2014
Previous terms of clearance apply.
  Inventory as of this Action Requested Previously Approved
04/30/2015 04/30/2015 04/30/2015
100 0 100
4,000 0 4,000
0 0 0
This submission is to account for non-substantive changes to 0920-0929 (World Trade Center Health Program Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center Health Program, expiration 4/30/2015). The James Zadroga 9/11 Health and Compensation Act of 2010 (the Act) established the World Trade Center (WTC) Health Program. The law requires the WTC Health Program to provide monitoring and treatment benefits to responders and survivors who are determined to be eligible for the Program. The Act included a list of WTC-related health conditions (42 CFR § 88.1) which are covered for treatment by the Program. The Act also allows any interested party to petition the WTC Program Administrator to add a condition to the list. The Program has created a form that has been approved by OMB (0920-0929) to help an individual(s) provide the necessary information to request the Program Administrator to add a condition.
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 100 100 0 0 0 0
Annual Time Burden (Hours) 4,000 4,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
The revised form improves clarity for the petitioner and to accurately reflect the current list of covered conditions. The following changes will be made: In the first sentence of the General Instructions section, the current petition refers people to page 5 for a full list of covered conditions. Since that list has changed over time we are going to remove that sentence and page 5 of the listed conditions and refer people to the website for the full and current list of covered conditions. This will prevent any future changes to the petition form as the current list is always updated on the website. The language was modified in section C1 to make it clearer what information needs to be provided by the petitioner in support of the petition. Minor grammatical changes have been made to throughout the form for clarity. No additional burden will be added to the respondents as this collection is already accounted for in the current OMB package (0920-0929). The respondent does not complete any additional paperwork as the edits are minor changes to current language on the applications.
$34,480
No
Yes
No
No
No
Uncollected
Catina Conner 4046394775
  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.
06/26/2014