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

ICR 202104-0906-002

OMB: 0906-0035

Federal Form Document

Forms and Documents
ICR Details
0906-0035 202104-0906-002
Received in OIRA 201902-0906-002
Federal Tort Claims Act (FTCA) Program Deeming Applications for Health Centers (Deeming)
Extension without change of a currently approved collection   No
Regular 04/06/2021
  Requested Previously Approved
36 Months From Approved 04/30/2021
1,160 1,160
2,900 2,900
0 0

Deemed status for FTCA medical malpractice coverage requires HRSA approval of an application for deemed status. This form provides HRSA with information that is essential for evaluating health center adherence to FTCA program requirements and making a determination as to whether a health center meets the statutory requirements for deemed PHS employee status for the purposes of FTCA coverage. Respondents will be not-for-profit institutions that receive health center funding.

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

Not associated with rulemaking

  86 FR 8364 02/05/2021
86 FR 17169 04/01/2021

IC Title Form No. Form Name
Federal Tort Claims Act (FTCA) Program Deeming Applications for Health Centers 1 0035 FTCA Health Center Application

  Total Request 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 1,160 0 0 0 0
Annual Time Burden (Hours) 2,900 2,900 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0

Elyana Bowman 301 443-3983 [email protected]


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:
    (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;
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.

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