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Form Approved OMB No. 0920-0891 Exp. Date 12/31/2011 World Trade Center Health Program Survivor Eligibility Application A World Trade Center (WTC) Health Program Survivor is a person who was present.

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How to fill out the Omb 0920 0891 online

The Omb 0920 0891 form is a vital document for individuals seeking eligibility in the World Trade Center Health Program. This guide provides a clear, step-by-step approach to filling out the form online, ensuring you understand each section and what information is needed.

Follow the steps to complete your application online.

  1. Press the ‘Get Form’ button to access the form and open it in the online editor.
  2. Begin by entering today's date in the required field. This date should reflect the current application date.
  3. Fill in your personal information starting with your last name, first name, and middle name in the designated fields.
  4. Provide your mailing address, including city, state, and zip code. Ensure that the information is accurate for correspondence purposes.
  5. Enter your email address as well as your primary and secondary phone numbers. This contact information may be used for communication regarding your application.
  6. Complete the date of birth field and select your gender by checking the appropriate box.
  7. You may choose to provide a Government Identification Number. This step is optional, but providing it can expedite the application process.
  8. Indicate your experience and connection to the World Trade Center disaster area by checking the applicable boxes and providing details about your presence in the area.
  9. Describe any physical or emotional health symptoms resulting from the September 11 attacks, if applicable, and include any additional information that supports your application.
  10. Submit the required documentation to support your eligibility, which can include proof of residence or employment during the relevant time. If you cannot provide documentation, explain your attempts to obtain it.
  11. Read the attestation statement carefully. By signing, you confirm the accuracy of your responses and compliance with the guidance provided.
  12. Sign and date the form. Ensure that your signature is present to validate the application.
  13. Once completed, proceed to save your changes, download or print the form, or share it as necessary.

Complete your form online today to begin your application for the WTC Health Program.

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The World Trade Center (WTC) Health Registry was established in 2002 by the NYC Department of Health to monitor the health of people directly exposed to the WTC disaster – those who lived, worked or went to school in the area of the disaster or were involved in rescue and recovery efforts.

The World Trade Center (WTC) Health Program provides medical monitoring and treatment of WTC-related health conditions for 9/11 responders and survivors.

WTC Health Program Enrollment by Member Type Member Type#%FDNY Responders17,05214%Survivors39,54031%Pentagon / Shanksville Responders1,2541%Total Members125,494100%1 more row • Sep 27, 2023

July 1, 2011 The WTC Health Program officially launched replacing the MMP and the WTC EHC. Individuals who were part of the previous Programs were automatically enrolled into the WTC Health Program.

The World Trade Center (WTC) Health Program was established by the James Zadroga 9/11 Health and Compensation Act of 2010 and is administered by the National Institute for Occupational Health and Safety (NIOSH) within the federal Centers for Disease Control and Prevention.

The WTC Health Program provides treatment for a specific list of physical and mental health conditions that have been determined to be caused by exposure to the 9/11 terrorist attacks. We also cover medically associated health conditions, which are caused by the progression or treatment of a covered condition.

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