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

ICR 202105-0915-001

OMB: 0915-0293

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
0915-0293 202105-0915-001
Received in OIRA 202010-0915-001
HHS/HSA
Federal Tort Claims Act (FTCA) Program Deeming Sponsorship Applications for Free Clinics
No material or nonsubstantive change to a currently approved collection   No
Regular 05/18/2021
  Requested Previously Approved
01/31/2024 01/31/2024
1,122 1,122
2,244 2,244
0 0

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.

US Code: 42 USC 233(o) Name of Law: Health Insurance Portability and Accountability Act of 1996
  
None

Not associated with rulemaking

  85 FR 47803 08/06/2020
85 FR 69628 11/03/2020
Yes

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,122 1,122 0 0 0 0
Annual Time Burden (Hours) 2,244 2,244 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$203,342
No
    No
    No
No
No
No
Yes
Elyana Bowman 301 443-3983 enadjem@hrsa.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/18/2021


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