FTCA Health Center Volunteer Health Professional Program Application

Application for Deemed Health Center Program Award Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0032 can be found here:

Documents and Forms

Document Name Document Type
Form 1 FTCA Health Center Volunteer Health Professional Program Application Form and Instruction
1 FTCA VHP Application CLEAN 0032 FTCA VHP Application CLEAN BPHC 9.23.20.docx Form and Instruction
1 T FTCA VHP Application tracked changes 0032 FTCA VHP Application tracked changes BPHC 9.23.20.docx Form and Instruction

Information Collection (IC) Details

IC Title:	FTCA Health Center Volunteer Health Professional Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	FTCA VHP Application CLEAN	0032 FTCA VHP Application CLEAN BPHC 9.23.20.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1 T	FTCA VHP Application tracked changes	0032 FTCA VHP Application tracked changes BPHC 9.23.20.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,156	Number of Respondents for Small Entity: 1,156

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,468	-657	4,125
Annual IC Time Burden (Hours)	6,936	-1,314	8,250
Annual IC Cost Burden (Dollars)	0	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.