Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
88.11 Denial Letter and Appeal Notification Eligibility Modified 47 24 0 Instruction
88.12 World Trade Center Health Condition Certification Request Modified 32200 16100 0 Form and Instruction 2
88.15 Denial Letter and Appeal Notification Treatment Modified 588 294 0
88.15 Denial Letter and Appeal Notification- Health Conditions Modified 30 15 0
88.16 Travel Expenses Modified 10 2 0
88.5 World Trade Center Health Program FDNY Responder Eligibility App Modified 189 95 0 Instruction
88.5 World Trade Center Health Program Responder App (Other than FDNY) Modified 2979 1490 0 Form and Instruction 88.5
88.9 World Trade Center Health Program Survivor Eligibility Application Modified 1560 390 0 Instruction
ACH Vendor/Miscellaneous Payment Enrollment Form Modified 200 50 0 Form and Instruction 11
Currently Identified Responders and Currently Identified Survivors Modified 290 48 0 Form 12
Outpatient Prescription Pharmaceuticals Modified 39150 653 0
Total burden requested under this ICR: 77243 19161 0  
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