Federal Tort Claims Act (FTCA) Program Deeming Applications for Health Centers (Deeming)

Forms and Documents

Document Name	Status
Form 1 Federal Tort Claims Act (FTCA) Program Deeming Applications for Health Centers Form and Instruction	New
FTCA Health Center Deeming PIA 02.01.18.pdf Supplementary Document	2018-03-06
FTCA Health Center Supporting Statement 01.31.18.docx Supporting Statement A	2018-03-06

IC Document Collections

IC ID	Document Title	Status
230498	Federal Tort Claims Act (FTCA) Program Deeming Applications for Health Centers Form and Instruction	New

ICR Details

OMB Control No: 0906-0035	ICR Reference No: 201803-0906-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Federal Tort Claims Act (FTCA) Program Deeming Applications for Health Centers (Deeming)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/06/2018
	Date Received in OIRA: 03/07/2018
Terms of Clearance: Approved consistent with the understanding that the burden statement will be included on both instruments as they appear in the EHB system and that he OMB number and expiration date will be displayed on every page of every form/instrument (per the supporting statement).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved
Responses	1,160	0	0
Time Burden (Hours)	2,900	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Deemed status for FTCA medical malpractice coverage requires HRSA approval of an application for deeming of certain eligible health centers. The FTCA Program Deeming Application for Health Centers is an electronic application submitted to HRSA through the Electronic Handbooks as part of the process of deeming qualified health centers.

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Authorizing Statute(s): US Code: 42 USC 233(g)-(n) Name of Law: Public Health and Welfare
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 28668	06/23/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 9525	03/06/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Federal Tort Claims Act (FTCA) Program Deeming Applications for Health Centers	2, 1	FTCA Health Center Deeming.Redeeming Application ,   FTCA Health Center Initial Application

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,160	0	0	1,160	0	0
Annual Time Burden (Hours)	2,900	0	0	2,900	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR, so burden increase is from zero.

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Annual Cost to Federal Government: $189,138

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/07/2018

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