OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

World Trade Center Health Program Enrollment & Appeals - Pentagon & Shanksville, PA Responders

OMB 0920-0962 · HHS/CDC.

OMB 0920-0962

Latest Forms, Documents, and Supporting Material

Document Name
Medical Travel Refund Request Form
Form SF 3881 SF 3881 ACH Vendor/Miscellaneous Payment Enrollment Form Form
WTC Pentagon & Shanksville, PA Eligibility Application Form
Appendix A Zadroga Act.docx Supplementary Document
Denial Letter Health Condition F-1.docx Supplementary Document
Denial Letter G-1 - Treatment.docx Supplementary Document
Denial Letter C-1 - Eligibility.docx Supplementary Document
World Trade Center Supptg Stmt A PA_VA application 3.29.13.docx Supporting Statement A
Medical Travel Refund Request Form
Outpatient Pharmacies Other-Document
SF 3881 ACH Vendor/Miscellaneous Payment Enrollment Form Form
Appeals regarding Certification of Health Conditions Other-Document
Appeals Regarding Treatment Other-Document
Appeals regarding Eligibility Denial Other-Document
WTC Pentagon & Shanksville, PA Eligibility Application Form

All Historical Document Collections

201304-0920-001

Approved without change

New collection (Request for a new OMB Control Number)

2013-04-01