FDNY Responder Eligibility Application

Welcome

A World Trade Center (WTC) Health Program FDNY Responder is a member of the Fire Department of the City of New York (whether fire or emergency personnel, active, or retired) who participated at least one day in the rescue and recovery effort at any of the former WTC sites. This application may also be used for certain family members of FDNY responders eligible for the WTC Health Program.

If you believe that you are eligible for enrollment in the WTC Health Program, please provide the following information to begin the eligibility determination process.

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0891).


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