OMB control number

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

OMB 0906-0090 · HHS/HRSA.

OMB 0906-0090

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.

The latest form for 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 expires 2027-05-31 and is listed under ICR 202512-0906-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 3 Emergency Deeming Sponsorship ApplicationForm and Instruction
Form 3 Emergency Deeming Sponsorship ApplicationForm and Instruction
Form 2 Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCAForm and Instruction
Form 2 Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCAForm and Instruction
Form 1 Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCAForm and Instruction
Form 1 Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCAForm and Instruction
Form 4 Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCAForm and Instruction
Form 4 Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCAForm and Instruction
0906 0090_BPHC_ FTCA_NSC Memo_12.10.2025.docxJustification for No Material/Nonsubstantive Change
0906 0090_BPHC_ FTCA_NSC Memo_12.10.2025.docx Justification for No Material/Nonsubstantive Change
FINAL PAL 2024-02 VHP Emergency Deeming Sponsorship Application.docxSupplementary Document
FINAL PAL 2024-02 VHP Emergency Deeming Sponsorship Application.docx Supplementary Document
Supporting Statement A- BPHC- Combined Package- 0906-New 04302024 Clean.docxSupporting Statement A
Supporting Statement A- BPHC- Combined Package- 0906-New 04302024 Clean.docxSupporting Statement A
Emergency Deeming Sponsorship Application Form and Instruction
Emergency Deeming Sponsorship Application Form and Instruction
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
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
Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA Form and Instruction
Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA Form and Instruction
Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA Form and Instruction
Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202512-0906-001 No material or nonsubstantive change to a currently approved collection 2025-12-11 Approved without change
202404-0906-001 New collection (Request for a new OMB Control Number) 2024-04-18 Approved with change

OMB Details

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

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form 4Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCAFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.