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Federal forms, ICRs, and supporting documents

Information Collection

Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA

IC 266935 under ICR 202512-0906-001 · OMB 0906-0090.

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

View Information Collection (IC)

Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA
 
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 4 Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA Clean_FTCA Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment 0906-0090.docx Yes Yes Fillable Fileable

Health Health Care Services

 

374 0
   
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 1,122 0 0 0 0 1,122
Annual IC Time Burden (Hours) 2,244 0 0 0 0 2,244
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Redline_FTCA Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment 0906-0090 Redline_FTCA Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment 0906-0090.pdf 12/10/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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