WORLD TRADE CENTER HEALTH PROGRAM

Forms

Designated Representative Form [PDF - 86 KB]
Members should complete this form to designate a representative for matters pertaining to the WTCHP. The representative will have permission to act on your behalf and receive access to your personal health information.

Mail Order Pharmacy Forms
This site will provide information on how to take part in the mail order pharmacy program under the WTCHP.

Responder Resources

NIOSH oversees programs that have been established to monitor, screen, treat and support responders who responded to the disaster site at the World Trade Center in New York City and who may have been affected physically or mentally by their service.

For FDNY Responders and General NYC Responders to enroll in the WTC Health Program, please download and complete the appropriate form available on the Enroll in the Program page and either mail or fax it to the address below.

WTC Health Program
P.O. Box 7001
Rensselaer, NY 12144
Fax number: 1-877-646-5308

If you have questions about completing the forms or submitting them, please contact us at 1-888-WTC-HP4U (1-888-982-4748)

If you are unable or have problems downloading the form, you may also ask for a hard copy to be mailed to you. To request a hardcopy of the form, please call us at 1-888-WTC-HP4U (1-888-982-4748)

Former MMTP Responders

If you have already been identified as a Responder you do not have to re-apply for care through the WTC Health Program. Your enrollment into the new program is being handled by NIOSH and you do not need to do anything unless notified otherwise. In the WTCHP you will continue to receive the same medical benefits at no cost. For more information on the program please contact our call center at (888)-WTC-HP4U.

What you need to know:

There are no changes to the health conditions covered by the program at this time.
Please continue to seek monitoring and treatment services at the same CCE you have visited in the past.
Continue to use your member identification number from the current MMTP. You will receive a new WTCHP Member ID card in August, 2011. Please continue to visit this website for updates.

If you have questions regarding your health care services, please contact your current Clinical Center of Excellence. For a full listing of the Clinical Centers of Excellence go to: http://www.cdc.gov/niosh/topics/wtc/clinics.html

If you have questions about the new WTCHP and your current enrollment:

Call us: 1-888-WTC-HP4U (1-888-982-4748)

Visit our Frequently Asked Questions: www.cdc.gov/niosh/topics/wtc/faq.html.

While we plan to make every effort to ensure a smooth transition to the new WTCHP, there may be issues that require additional attention and information. Our goal is to provide the best service possible during this transition to the new WTCHP and to provide you with the best quality health care.

Information for 9/11 Pentagon and Shanksville Responders