2024-25556. Proposed Data Collection Submitted for Public Comment and Recommendations

Estimated Annualized Burden Hours

Type of respondent	Form name	Number of respondents	Number of responses per respondent	Average burden per response (in hours)	Total burden hours
FDNY Responder	World Trade Center Health Program FDNY Responder Application for Enrollment	140	1	30/60	70
( print page 87588)
General Responder	World Trade Center Health Program Responder Application for Enrollment (Other than FDNY)	6,215	1	30/60	3,108
Pentagon/Shanksville Responder	World Trade Center Health Program Pentagon/Shanksville Responder Application for Enrollment	742	1	30/60	371
WTC Survivor	World Trade Center Health Program Survivor Application for Enrollment (all languages)	9,240	1	30/60	4,620
General responder	Clinic Selection Postcard for new general responders in NY/NJ to select a clinic	3,830	1	15/60	958
Interested Party	Petition for the addition of health conditions	35	1	1	35
Program Applicants or Members	Designated Representative Appointment Form	1,300	1	15/60	325
Program Applicants or Members	Designated Representative HIPAA Release Form	1,300	1	15/60	325
Program Members	Member Satisfaction Survey	6,600	1	30/60	3,300
General Public	WTC Health Program HIPAA Authorization for Deceased Individuals	30	1	15/60	8
Program Applicants or Members	WTC Health Program General HIPAA Authorization to Third Parties	30	1	15/60	8
Program Applicants or Members	Designated Representative Appointment Form	15	1	15/60	4
Youth Research Cohort Enrollees	Youth Research Cohort Registration Portal	6,000	1	30/60	3,000
Total					16,132