WORLD TRADE CENTER HEALTH PROGRAM
Survivor Resources
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.
Survivors who have been certified as eligible for an initial screening will receive a one-time free medical screening evaluation at no cost. If survivors are then certified as having a WTC covered condition, they will continue to receive monitoring and treatment services as no cost. This program is funded by the Federal Government.
There are three Center locations: Bellevue Hospital on the East Side of Manhattan, Elmhurst Hospital in Queens and Gouverneur Healthcare Services in Lower Manhattan. For a full listing of the Clinical Centers of Excellence go to: http://www.cdc.gov/niosh/topics/wtc/clinics.html
If you are a Survivor who has been notified that you are eligible to receive a screening appointment, please contact the Environmental Health Center at 877-982-0107 or visit http://www.nyc.gov/html/hhc/html/services/wtc-health-center.shtml.
To enroll:
To apply to the WTC Health Program, please download and complete the appropriate form available on the World Trade Center Health 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 EHC Community Program Members
If you are a Survivor who has been notified that you are eligible to receive a screening appointment, please contact the Environmental Health Center or visit http://www.nyc.gov/html/hhc/html/services/wtc-health-center.shtml.
Contact Us:
- National Institute for Occupational Safety and Health (NIOSH)
- Centers for Disease Control and Prevention
- 800-CDC-INFO
(800-232-4636)
TTY: (888) 232-6348 - New Hours of Operation
8am-8pm ET/Monday-Friday
Closed Holidays - cdcinfo@cdc.gov



