Complete and Submit an Application
You can apply online or download a form and send it by mail or fax. You may choose to have someone represent your interests when applying to the WTC Health Program and as a member. Learn how to officially Designate a Representative for this purpose.
Your application must have all pages filled out, your required supporting documentation, and a signature form signed with ink.
Apply Online
Apply with the online application system (OASIS). The following must be included when submitting your application:
- all supporting documentation, and
- a completed signature form signed with ink, electronic signatures are not accepted (Online Application Signature Form [PDF, 7 pages, 245 KB] )
Save a copy of your online application for your records. We recommend you bring it to your first appointment.
Apply by Mail or Fax
- Download the application, located below. Fill it out digitally or print it and fill it out by hand.
- Sign the signature form with ink (electronic signatures are not accepted).
- Mail or fax the application with the required supporting documentation.
- Make a copy for your records. We recommend you bring it to your first appointment.
FDNY Responder Eligibility Application:
Responder Eligibility Application (Other than FDNY):
Guide to the WTC General Responder Application English (PDF, 4 pages, 3.2 MB)
Survivor Eligibility Application:
Guide to the WTC Survivor Application English (PDF, 4 pages, 3 MB)
Pentagon/Shanksville Responder Eligibility Application:
Mailing Addresses
Regular Mail:
WTC Health Program
P.O. Box 7000
Rensselaer, NY 12144
Shipping Service (e.g., FedEx, UPS) or Certified Mail:
WTC Health Program
327 Columbia Turnpike
Rensselaer, NY 12144
Fax Number
Fax your application and supporting documentation to 1-877-646-5308
Important Program and Privacy Notices
By signing and submitting your application, you are agreeing that you have read and understand the following important Program and privacy notices:
- WTC Health Program Requirements, Services, and Benefits
- Privacy Act Statement and Additional Permitted Disclosures of Personally Identifiable Information and Records
- Notice of Privacy Practices Regarding Your Personal Health Information
Please note: This information is also included in the downloadable applications above and on the online application downloadable signature form.
What Happens Next?
We will start processing your application as soon as we receive it. The WTC Health Program will consider requests to expedite enrollment applications for reasons of medical necessity. These reasons may include if you have a newly diagnosed cancer, are in active cancer treatment, are terminally ill, or in hospice due to a health condition that is believed to be related to 9/11 exposures. Please call our call center at 888-982-4748 for assistance.
After your application is reviewed, if we need additional information to finish processing your application we will call, email, or write to you request it.
If you have submitted all of the required information and we are able to make an enrollment decision, we will send you a letter letting you know if you are eligible for enrollment in the WTC Health Program.
If you are not accepted, the letter will explain how you can appeal that decision.
Contact Us
If you have questions about the application process or about your individual application, please contact us toll-free at 1-888-982-4748 or email the Program at WTC@cdc.gov.
To protect your privacy, please do not email sensitive information, including personal health information.
We do NOT accept applications by email.
WTC Health Program Notice of Privacy Practices—this notice describes how medical information about WTC Health Program members may be used and disclosed and how WTC Health Program members can get access to this information. The effective date for this notice is Monday, September 30, 2013.