Information Collection Request
Applications for Deemed Public Health Service Employment with Liability Protections Under the FTCA for Health Centers, Deemed Health Center Volunteers, and Free Clinic Sponsored Individuals
ICR 202404-0906-001 · OMB 0906-0090 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0906-0090 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 3 Emergency Deeming Sponsorship Application |
Form and Instruction | New | Repair queued |
| Form 2 Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCA |
Form and Instruction | New | Repair queued |
| Form 1 Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA |
Form and Instruction | New | Repair queued |
| Form 4 Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA |
Form and Instruction | New | Repair queued |
 FINAL PAL 2024-02 VHP Emergency Deeming Sponsorship Application.docx |
Supplementary Document | Uploaded 2024-04-17 | Repair queued |
| Supporting Statement A- BPHC- Combined Package- 0906-New-4.15.24.docx |
Supporting Statement A | Uploaded 2024-04-17 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 266942 |  Emergency Deeming Sponsorship Application |
Form and Instruction | New | |
| 266941 | Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCA |
Form and Instruction | New | |
| 266939 | Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA |
Form and Instruction | New | |
| 266935 | Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA |
Form and Instruction | New |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/HRSA |
| OMB Control No | 0906-0090 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |