OMB control number

Federal Tort Claims Act (FTCA) Program Deeming Sponsorship Applications for Free Clinics

OMB 0915-0293 · HHS/HSA.

OMB 0915-0293

Deemed status for FTCA medical malpractice coverage requires HRSA approval of an application for deeming of certain eligible individuals from a sponsoring Free Clinic. The FTCA Program Deeming Sponsorship Application for Free Clinics is an electronic application submitted to HRSA through the Electronic Handbooks as part of the process of deeming qualified health care professionals, board members, officers, and individual contractors.

The latest form for Federal Tort Claims Act (FTCA) Program Deeming Sponsorship Applications for Free Clinics expires 2024-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1 Federal Tort Claims Act (FTCA) Program Deeming Sponsorship Applications for Free Clinics Form
0293 Free Clinic Application Non Substantive Change Memo - CLEAN.docx Justification for No Material/Nonsubstantive Change
0293 60 Day FRN Comment Chart October 2020.docx Supplementary Document
0293 Supporting Statement Ocotober 2020 BPHC.docx Supporting Statement A
0293 Privacy Impact Assessment.pdf Supplementary Document
Federal Tort Claims Act (FTCA) Program Deeming Sponsorship Applications for Free Clinics Form

All Historical Document Collections

202105-0915-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-05-18
202010-0915-001 Approved without change	Revision of a currently approved collection	2020-11-04
201807-0915-002 Approved with change	No material or nonsubstantive change to a currently approved collection	2018-07-27
201709-0915-002 Approved with change	Revision of a currently approved collection	2017-10-25
201408-0915-001 Approved without change	Revision of a currently approved collection	2014-08-28
201108-0915-003 Approved without change	Revision of a currently approved collection	2011-08-31
200807-0915-004 Approved without change	Revision of a currently approved collection	2008-07-31
200507-0915-003 Approved without change	Revision of a currently approved collection	2005-07-07
200503-0915-001 Withdrawn and continue	Revision of a currently approved collection	2005-03-24
200409-0915-002 Approved with change	New collection (Request for a new OMB Control Number)	2004-09-13