A Pentagon/Shanksville Responder is an individual who performed rescue, recovery, demolition, debris
cleanup or other related services and the Pentagon crash site in Arlington, Virginia, from September 11, 2001, to
November 19, 2001; or the crash site in Shanksville, Pennsylvania from September 11, 2001, to October 3, 2001. Eligible
individuals must have been a member of a fire or police department (whether fire or emergency personnel, active or
retired), worked for a recovery or cleanup contractor, was a volunteer, was an employee of the Department of Defense or
any other Federal agency, worked for a contractor of the Department of Defense or any other Federal agency for at least
one day between September 11, 2001, and September 18, 2001, or was a member of a regular or reserve component of
the uniformed services.
Please select the location at which you worked or volunteered:
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.
Important! WTC Health Program online applicants now must print, hand sign, and upload a signature form before an application can be submitted. This is the final step in the online application.
The WTC Health Program WILL NOT process your online application without this signature form.
Please note: Once you start your application you cannot save it and complete it later.
Be sure to have your supporting documentation and completed signature form ready to upload before starting.
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).