Information Collection

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

IC 230498 under ICR 202104-0906-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 0035 FTCA Health Center Application FORM 0035 FTCA Health Center Application with OMB Statement_03.11.21_FINAL.docx	Form and Instruction
1 0035 FTCA Health Center Application FORM 0035 FTCA Health Center Application with OMB Statement_03.11.21_FINAL.docx	Form and Instruction

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	0035 FTCA Health Center Application	FORM 0035 FTCA Health Center Application with OMB Statement_03.11.21_FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,160

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
No associated records found

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