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Click ‘Get Form’ to open the WTC-12 form in the editor.
Begin by entering your current residential address in Item 1, including apartment number, street name, city, state, and zip code. Don’t forget to provide your telephone number and Social Security Number.
In Item 2, confirm your participation in World Trade Center operations between September 11, 2001, and September 12, 2002.
Specify whether you participated as an employee or a volunteer in Item 3.
For Item 4, list any evidence of your activities as a volunteer such as badges or letters.
Complete Item 5 by detailing the dates and locations of your participation along with descriptions of the work performed.
Indicate in Item 6 if you have previously filed a workers' compensation claim related to this participation.
Review all entries for accuracy before signing the Sworn Statement in front of a notary public as instructed.
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