Information Collection

Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA

IC 266939 under ICR 202404-0906-001 · OMB 0906-0090.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0090 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA Form and Instruction
1 Application for Health Center Program Recipients for Dee Health Center Deeming Application Tool.pdf Form and Instruction
1 Application for Health Center Program Recipients for Dee Health Center Deeming Application Tool.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA	Health Center Deeming Application Tool.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,160	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,160	1,160
Annual IC Time Burden (Hours)	2,900	2,900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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