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Federal forms, ICRs, and supporting documents

Information Collection

FTCA Health Center Volunteer Health Professional Program Application

IC 227945 under ICR 202104-0906-003 · OMB 0906-0032.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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FTCA Health Center Volunteer Health Professional Program Application
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 T 0032 FTCA VHP Application tracked changes from last OMB FINAL.docx 0032 FTCA VHP Application tracked changes from last OMB FINAL.docx Yes Yes Fillable Fileable
Form and Instruction 1 0032 FTCA VHP Application CLEAN.docx 0032 FTCA VHP Application CLEAN.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,156 1,156
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,468 0 0 0 0 3,468
Annual IC Time Burden (Hours) 6,936 0 0 0 0 6,936
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0032 Non Substantive Change Memo - OMB PPR 2020_HRSA BPHC 3.31.21 FINAL 0032 Non Substantive Change Memo - OMB PPR 2020_HRSA BPHC 3.31.21 FINAL.docx 04/06/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.