Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCA

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

Documents and Forms

Document Name Document Type
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
2 Application for Deemed Health Center Program Recipients Clean_ FTCA Application for Deemed Health Center Program Recipients to Sponsor VHPs Tool 0906-0090.docx Form and Instruction
Redline_ FTCA Application for Deemed Health Center Program Recipients to Sponsor VHPs Tool 0906-0090.pdf Redline_ FTCA Application for Deemed Health Center Program Recipients to Sponsor VHPs Tool 0906-0090 IC Document

Information Collection (IC) Details

IC Title:	Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCA	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	2	Application for Deemed Health Center Program Recipients to Sponsor Volunteer Health Professionals (VHPs) for Deemed PHS Employment with Liability Protections Under the FTCA	Clean_ FTCA Application for Deemed Health Center Program Recipients to Sponsor VHPs Tool 0906-0090.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: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	3,468	3,468
Annual IC Time Burden (Hours)	6,936	6,936
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Redline_ FTCA Application for Deemed Health Center Program Recipients to Sponsor VHPs Tool 0906-0090	Redline_ FTCA Application for Deemed Health Center Program Recipients to Sponsor VHPs Tool 0906-0090.pdf	12/10/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.