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

ICR 202404-0906-001

OMB: 0906-0090

Federal Form Document

Forms and Documents

Document Name	Status
Form 3 Emergency Deeming Sponsorship Application Form and Instruction	New
Form 2 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	New
Form 1 Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA Form and Instruction	New
Form 4 Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA Form and Instruction	New
FINAL PAL 2024-02 VHP Emergency Deeming Sponsorship Application.docx Supplementary Document	2024-04-17
Supporting Statement A- BPHC- Combined Package- 0906-New-4.15.24.docx Supporting Statement A	2024-04-17

IC Document Collections

IC ID	Document Title	Status
266942	Emergency Deeming Sponsorship Application Form and Instruction	New
266941	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	New
266939	Application for Health Center Program Recipients for Deemed PHS Employment with Liability Protections Under the FTCA Form and Instruction	New
266935	Application for Free Clinics to Sponsor Individuals for Deemed PHS Employment with Liability Protections Under the FTCA Form and Instruction	New