Information Collection

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

IC 188198 under ICR 201103-3060-042 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form FCC Form 499-A FCC Forms 499-A and 499-Q, Telecommunications Reporting Worksheets	Form and Instruction
FCC Form 499-Q Instructions (OMB Approved Version).doc forms.universalservice.org	Instruction
FCC Form 499-A 2011 Telecommunications Reporting Worksheet FCC Form 499-A Complete (2011 revised).pdf forms.universalservice.org	Form and Instruction
FCC Form 499-A 2012 Telecommunications Reporting Worksheet FCC Form 499-A Complete (2012 with TRS).pdf forms.universalservice.org	Form and Instruction
FCC Form 499-Q Telecommunications Reporting Worksheet FCC Form 499-Q (OMB Approved Version).pdf forms.universalservice.org	Form

IC Title:

FCC Forms 499-A and 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
Form and Instruction	FCC Form 499-A	2011 Telecommunications Reporting Worksheet	FCC Form 499-A Complete (2011 revised).pdf	http://forms.universalservice.org	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC Form 499-A	2012 Telecommunications Reporting Worksheet	FCC Form 499-A Complete (2012 with TRS).pdf	http://forms.universalservice.org	Yes	Yes	Fillable Fileable Signable
Instruction			FCC Form 499-Q Instructions (OMB Approved Version).doc	http://forms.universalservice.org	Yes	No	Fillable Fileable Signable
Form	FCC Form 499-Q	Telecommunications Reporting Worksheet	FCC Form 499-Q (OMB Approved Version).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: 8,183

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: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	46,957	2,383	44,574
Annual IC Time Burden (Hours)	313,881	32,171	281,710
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.