Free Clinic Application Process
The application process documented on this page is provided as a guide. Please refer to the applicable Program Assistance Letters (PALs) and Policy Information Notices (PINs) for specific details.
Effective March 31, 2016, free clinics that apply for the first time to the FTCA Free Clinic Program will be required to have a DUNS number and be registered within the System for Award Management (SAM), in order to create an account and submit an initial application via the Electronic Handbook (EHB). For more information about the new initial application process, please see the, current PAL (PDF - 337 KB).
Free clinics that currently sponsor deemed individuals must reapply on an annual basis for continued FTCA coverage. The annual redeeming application form should be submitted using HRSA’s web based Electronic Handbook (EHB) system. For more information, see the current PAL (PDF - 337 KB).
During the course of the year, sponsoring free clinics may wish to add additional eligible individuals for FTCA coverage. In order to supplement the free clinic’s list of covered individuals, a supplemental application must be completed and submitted. The supplemental application should be submitted using HRSA’s web based Electronic Handbook (EHB) system.
General Application Submission Instructions
As a part of continued efforts to streamline and automate data reporting processes, the Bureau of Primary Health Care (BPHC) has developed a Free Clinic FTCA deeming module within the HRSA EHB. View the EHB web based application.
All Initial, Redeeming, and Supplemental applications require an attachment explaining any and all disciplinary actions and medical malpractice claims alleged against the eligible individuals applying for deeming. This information is required for the past ten (10) years for new applicants and five (5) years for renewal applicants. Please do not attach a report from the National Practitioner Data Bank (NPDB). These reports do not describe the actions taken by the sponsoring free clinic or the applicant in response to the claims. Additionally, an NPDB report may disclose information exceeding the time frame requested.
FTCA Free Clinic Checklist (PDF - 75 KB)
Free Clinic Application Categories (PDF - 75 KB)