Information Collection

FTCA Health Center Volunteer Health Professional Program Application

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 T FTCA Health Center Volunteer Health Professional Program Application	Form and Instruction
Form 1 T 0032 FTCA VHP Application tracked changes from last OMB FINAL.docx FTCA Health Center Volunteer Health Professional Program Application	Form and Instruction
Form 1 0032 FTCA VHP Application CLEAN.docx FTCA Health Center Volunteer Health Professional Program Application	Form and Instruction
1 T 0032 FTCA VHP Application tracked changes from last OMB 0032 FTCA VHP Application tracked changes from last OMB FINAL.docx	Form and Instruction
1 T 0032 FTCA VHP Application tracked changes from last OMB 0032 FTCA VHP Application tracked changes from last OMB FINAL.docx	Form and Instruction
1 0032 FTCA VHP Application CLEAN.docx 0032 FTCA VHP Application CLEAN.docx	Form and Instruction
1 0032 FTCA VHP Application CLEAN.docx 0032 FTCA VHP Application CLEAN.docx	Form and Instruction
0032 Non Substantive Change Memo - OMB PPR 2020_HRSA BPHC 3.31.21 FINAL.docx 0032 Non Substantive Change Memo - OMB PPR 2020_HRSA BPHC 3.31.21 FINAL	IC Document
0032 Non Substantive Change Memo - OMB PPR 2020_HRSA BPHC 3.31.21 FINAL.docx 0032 Non Substantive Change Memo - OMB PPR 2020_HRSA BPHC 3.31.21 FINAL	IC Document

IC Title:

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 T				Yes	Yes	Fillable Fileable
Form and Instruction	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,156

Number of Respondents for Small Entity: 1,156

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	3,468	3,468
Annual IC Time Burden (Hours)	6,936	6,936
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0032 Non Substantive Change Memo - OMB PPR 2020_HRSA BPHC 3.31.21 FINAL		04/06/2021

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

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