OMB control number
Application for Health Center Program Recipients for Deemed Public Health Service Employment with Liability Protections Under the Federal Tort Claims Act (FTCA)
OMB 0906-0035 · HHS/HRSA.
OMB 0906-0035
Deemed status for FTCA medical malpractice coverage requires HRSA approval of an application for deeming of certain eligible health centers. The FTCA Program Deeming Application for Health Centers is an electronic application submitted to HRSA through the Electronic Handbooks as part of the process of deeming qualified health centers.
The latest form for Application for Health Center Program Recipients for Deemed Public Health Service Employment with Liability Protections Under the Federal Tort Claims Act (FTCA) expires 2021-04-30 and is listed under ICR 201902-0906-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 1 Application for Health Center Program Recipients for Deemed Public Health Service Employment with Liability Protections Under the Federal Tort Claims Act (FTCA) | Form and Instruction |
| 0035 FTCA Health Center Supporting Statement 3.8.22.docx | Supporting Statement A |
 FTCA Health Center Deeming PIA 02.01.18.pdf | Supplementary Document |
 Application for Health Center Program Recipients for Deemed Public Health Service Employment with Liability Protections Under the Federal Tort Claims Act (FTCA) |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202203-0906-003 | Revision of a currently approved collection | 2022-04-04 | Approved without change | |
| 202104-0906-002 | Extension without change of a currently approved collection | 2021-04-06 | Approved without change | |
| 201902-0906-002 | No material or nonsubstantive change to a currently approved collection | 2019-02-26 | Approved with change | |
| 201803-0906-001 | Existing collection in use without an OMB Control Number | 2018-03-07 | Approved without change |