Information Collection

FTCA Health Center Volunteer Health Professional Program Application

IC 227945 under ICR 201711-0906-003 · OMB 0906-0032.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0032 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 FTCA Health Center Volunteer Health Professional Program Application	Form and Instruction
1 FTCA VHP Application FTCA VHP Application 08.01.17.docx	Form and Instruction

IC Title:

FTCA Health Center Volunteer Health Professional Program Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	FTCA VHP Application	FTCA VHP Application 08.01.17.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,375

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,125	4,125
Annual IC Time Burden (Hours)	8,250	8,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.