NYC Survivor Eligibility Application


A World Trade Center (WTC) Health Program Survivor includes a person who was present in the New York City Disaster Area in the aftermath of the September 11, 2001, terrorist attacks on the WTC as a result of their work, residence, or attendance at school, childcare, or adult daycare.

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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