Information Collection

FCC Form 499-A, and FCC Form 499-Q, Telecommunications Reporting Worksheets

IC 188198 under ICR 201005-3060-004 · OMB 3060-0855.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0855 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0855_FCCForm499-A_Instructions_Revised 2010_021810.doc forms.universalservice.org	Instruction
0855_FCCForm499-Q_Instructions_ Revised 2010_021810.doc forms.universalservice.org	Instruction
FCC Form 499-A Telecommunications Reporting Worksheet 0855_FCCForm499A_Revised2010_021810.pdf forms.universalservice.org	Form
FCC Form 499-Q Telecommunications Reporting Worksheet 0855_FCC 499Q_Revised2010_021810.pdf forms.universalservice.org	Form

IC Title:

FCC Form 499-A, and FCC Form 499-Q, Telecommunications Reporting Worksheets

Agency IC Tracking Number:

WCB

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 47 CFR 54.711 47 CFR 54.706 47 CFR 1.47 47 CFR 54.709

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			0855_FCCForm499-A_Instructions_Revised 2010_021810.doc	http://forms.universalservice.org	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 499-A	Telecommunications Reporting Worksheet	0855_FCCForm499A_Revised2010_021810.pdf	http://forms.universalservice.org	Yes	Yes	Fillable Fileable Signable
Instruction			0855_FCCForm499-Q_Instructions_ Revised 2010_021810.doc	http://forms.universalservice.org	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 499-Q	Telecommunications Reporting Worksheet	0855_FCC 499Q_Revised2010_021810.pdf	http://forms.universalservice.org	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,800

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	44,574	8,506	36,068
Annual IC Time Burden (Hours)	281,710	8,581	273,129
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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