Information Collection

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

IC 230498 under ICR 201902-0906-002 · OMB 0906-0035.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0035 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Federal Tort Claims Act (FTCA) Program Deeming Applications for Health Centers	Form and Instruction
1 FTCA Health Center Deeming.Redeeming Application FTCA Health Center Deeming.Redeeming Application 01.30.18.pdf	Form and Instruction
2 FTCA Health Center Initial Application FTCA Health Center Initial Application 01.30.18.pdf	Form and Instruction
0035 - FTCA HC Change Memo 02.21.19.docx Change Memo	IC Document
0035 - FTCA HC CY20 Application (tracked) 02.20.19.pdf Tracked Changes PDF	IC Document

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 Health Center Deeming.Redeeming Application	FTCA Health Center Deeming.Redeeming Application 01.30.18.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	FTCA Health Center Initial Application	FTCA Health Center Initial Application 01.30.18.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,160

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,160	1,160
Annual IC Time Burden (Hours)	2,900	2,900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Change Memo	0035 - FTCA HC Change Memo 02.21.19.docx	03/04/2019
Tracked Changes PDF	0035 - FTCA HC CY20 Application (tracked) 02.20.19.pdf	03/04/2019

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