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

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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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All Historical Document Collections

202203-0906-003 Approved without change	Revision of a currently approved collection	2022-04-04
202104-0906-002 Approved without change	Extension without change of a currently approved collection	2021-04-06
201902-0906-002 Approved with change	No material or nonsubstantive change to a currently approved collection	2019-02-26
201803-0906-001 Approved without change	Existing collection in use without an OMB Control Number	2018-03-07