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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 Emergency Deeming Sponsorship Application	Form and Instruction	New	Available
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	Available
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	Available
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	Available
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

Information collection document groups

IC ID	Collection	Type	Status	Form
266942	Emergency Deeming Sponsorship Application	Form and Instruction	New	Emergency Deeming Sponsorship Application
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	Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCA
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	Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA
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	Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA
266935	Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA	Form and Instruction	New

ICR Details

OMB Control No: 0906-0090	ICR Reference No: 202404-0906-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: 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
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/03/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/18/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved
Responses	5,810	0	0
Time Burden (Hours)	12,140	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 224(g)-(n) of the PHS Act (42 U.S.C. 233(g)-(n)) states that entities receiving funds under section 330 of the PHS Act and specified individuals of that entity may be deemed to be PHS employees for the purpose of eligibility for liability protections, including FTCA coverage, for the performance of medical, surgical, dental, and related functions within the scope of deemed employment upon approval of an application for deemed employment. The Health Center Program and Health Center FTCA Program are administered by HRSA. Health centers submit deeming applications annually to HRSA in the prescribed form and manner in order to obtain deemed PHS employee status, with the associated eligibility for FTCA coverage. Such applications must be approved by HRSA in a Notice of Deeming Action. Deemed health centers must resubmit applications annually meeting all deeming requirements in order to maintain deemed status.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 86346	12/13/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 22163	03/29/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCA	2	Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCA
Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA	4	Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA
Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA	1	Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA
Emergency Deeming Sponsorship Application	3	Emergency Deeming Sponsorship Application

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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	5,810	0	0	5,810	0	0
Annual Time Burden (Hours)	12,140	0	0	12,140	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Reuploaded form and respondent numbers.

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Annual Cost to Federal Government: $786,398

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.     No

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.     No

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

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Common Form ICR:  No

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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: 04/18/2024

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