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 201503-0920-016 · OMB 0920-0929 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center 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 Available
HSRB 15-OD-NR01 010815 WeissR WTC-related health condition.docx Supplementary Document Uploaded 2015-04-03 Available
Appendix A.docx Supplementary Document Uploaded 2015-04-03 Available
Attachment A_Zadroga Act.pdf Supplementary Document Uploaded 2015-04-03 Available
Att B 60 Day.pdf Supplementary Document Uploaded 2015-04-03 Available
Supporting Statement B.docx Supporting Statement B Uploaded 2015-04-03 Available
Supporting Statement A.docx Supporting Statement A Uploaded 2015-04-03 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
IC Document Collections
IC IDCollectionTypeStatusForm
215958 Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center Form and Instruction New
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 Removed
ICR Details
0920-0929 201503-0920-016
Historical Active 201406-0920-015
HHS/CDC 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 (WTC) Health Program
Revision of a currently approved collection   No
Regular
Approved without change 07/09/2015
Retrieve Notice of Action (NOA) 04/07/2015
Approved consistent with the provisions of the associated final rule (RIN 0920-AA45).
  Inventory as of this Action Requested Previously Approved
07/31/2018 36 Months From Approved 07/31/2015
20 0 100
800 0 4,000
0 0 0
PHS Act §3312(a)(3) identifies a list of health conditions for which individuals who are enrolled in the WTC Health Program may be monitored or treated. PHS Act §3312(a)(6)(B) specifies that interested parties may petition the Administrator of the WTC Health Program to request that a new health condition be added to the List of WTC-Related Health Conditions in 42 C.F.R. §88.1. To aid the petitioner, the WTC Health Program provides a petition form to be completed and then sent to the Administrator for review. However, the petitioner is not required to use the form, and may submit a petition in a different format, provided it contains all of the data elements requested on the form.
PL: Pub.L. 111 - 347 3312 Name of Law: James Zadroga 9/11 Health and Compensation Act of 2010
  
None
Not associated with rulemaking
  80 FR 3239 01/22/2015
80 FR 18238 04/03/2015
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 20 100 0 0 -80 0
Annual Time Burden (Hours) 800 4,000 0 0 -3,200 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
ICR Revision 0920-0929 is a revision of the ICR to allow individuals to submit petitions to add conditions to a list of conditions for which enrollees in the WTC Health Program can be monitored.
$34,480
No
Yes
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [email protected]
  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.
04/07/2015