Application for Deemed Health Center Program Award Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 0032 FTCA VHP Application CLEAN.docx	Form and Instruction	Modified	Available
Form 1 T 0032 FTCA VHP Application tracked changes from last OMB FINAL.docx	Form and Instruction	Modified	Available
Form 1 T FTCA Health Center Volunteer Health Professional Program Application	Form and Instruction	Modified	Repair queued
0032 Non Substantive Change Memo - OMB PPR 2020_HRSA BPHC 3.31.21 FINAL.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-04-06	Repair queued
Supporting Statement A 0032 FTCA VHP.docx	Supporting Statement A	Uploaded 2020-10-01	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227945	FTCA Health Center Volunteer Health Professional Program Application	Form and Instruction	Modified	0032 FTCA VHP Application CLEAN.docx
227945	FTCA Health Center Volunteer Health Professional Program Application	Form and Instruction	Modified	0032 FTCA VHP Application tracked changes from last OMB FINAL.docx
227945	FTCA Health Center Volunteer Health Professional Program Application	Form and Instruction	Modified

ICR Details

OMB Control No: 0906-0032	ICR Reference No: 202104-0906-003
Status: Historical Active	Previous ICR Reference No: 202010-0906-002
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Application for Deemed Health Center Program Award Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/08/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/06/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2023	12/31/2023	12/31/2023
Responses	3,468	0	3,468
Time Burden (Hours)	6,936	0	6,936
Cost Burden (Dollars)	0	0	0

---

Abstract: Deemed status for FTCA medical malpractice coverage requires HRSA approval of an application for deeming of certain eligible individuals from a sponsoring health center. The FTCA Program Deeming Application for Health Center Volunteer Health Professionals is an electronic application submitted to HRSA through the Electronic Handbooks as part of the process of deeming qualified volunteers of health centers.

---

Authorizing Statute(s): US Code: 42 USC 233(q0 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 44101	07/21/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 62746	10/05/2020
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
FTCA Health Center Volunteer Health Professional Program Application	1 T , 1	0032 FTCA VHP Application tracked changes from last OMB FINAL.docx ,   0032 FTCA VHP Application CLEAN.docx

---

ICR Summary of Burden

table that charts list 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	3,468	3,468	0	0	0	0
Annual Time Burden (Hours)	6,936	6,936	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $64,488

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? No

---

Common Form ICR:  No

---

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: 04/06/2021

---