Information Collection

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

IC 188198 under ICR 201103-3060-025 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form FCC Form 499-A FCC Form 499-A, and FCC Form 499-Q, Telecommunications Reporting Worksheets Form
0855_FCCForm499-Q_Instructions_ Revised 2010_021810.doc forms.universalservice.org Instruction
0855_FCC499A_032211.pdf 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
FCC Form 499A Telecommunications Reporting Worksheets - Annual 0855_FCC499A_030211.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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 1.47 47 CFR 54.709 47 CFR 54.711 47 CFR 54.706

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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
Form	FCC Form 499A	Telecommunications Reporting Worksheets - Annual	0855_FCC499A_030211.pdf		Yes	Yes	Fillable Fileable Signable
Instruction			0855_FCC499A_032211.pdf		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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	44,574	44,574
Annual IC Time Burden (Hours)	281,710	281,710
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.