OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

World Trade Center Enrollment & Appeals - Pentagon & Shanksville

OMB 0920-1001 · HHS/CDC.

OMB 0920-1001

Latest Forms, Documents, and Supporting Material

Document Name
Responder Travel Refund Request Form
Responder Eligibility Application Form and Instruction
Supporting Statement B 11.1.13.docx Supporting Statement B
Appendix K.pdf Supplementary Document
Appendix J.pdf Supplementary Document
Appendix I.docx Supplementary Document
60 day FRN.pdf Supplementary Document
Appendix A Zadroga Act.docx Supplementary Document
Denial Letter F-1 - Treatment.docx Supplementary Document
Denial Letter Health Condition E-1.docx Supplementary Document
Denial Letter C-1 - Eligibility.docx Supplementary Document
World Trade Center Supptg Stmt A PA_VA application 11 7 13.docx Supporting Statement A
Responder Travel Refund Request Form
Pharmacies Outpatient Prescription Pharmaceuticals Other-Electronic Claims Submission
Responder Appeals Treatment Other-Letter
Responder Appeals Certification of Health Conditions Other-Letter
Responder Appeals to Eligibility Denial Other-Letter
Responder Eligibility Application Form and Instruction

All Historical Document Collections

201311-0920-009

Approved without change

New collection (Request for a new OMB Control Number)

2013-11-14