Information Collection

Universal Service - Rural Health Care Program/Rural Health Care Pilot Program

IC 31049 under ICR 201110-3060-005 · OMB 3060-0804.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0804 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0804_FCC465Instructions_100411.doc	Instruction
0804_FCC466Instructions_100411.doc	Instruction
0804_FCC466AInstructions_100411.doc	Instruction
0804_FCC467Instructions_100411.doc	Instruction
FCC Form 465 Rural Health Care Universal Service Mechanism 0804_FCC465_100411.xls	Form
FCC Form 466 Funding Request and Certification Form 0804_FCC466_100411.xls	Form
FCC Form 466-A Internet Service Funding Request and Certification Form 0804_FCC466A_100411.xls	Form
FCC Form 467 Connection Certification 0804_FCC467_100411.xls	Form

IC Title:

Universal Service - Rural Health Care Program/Rural Health Care Pilot Program

Agency IC Tracking Number:

WCB

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54.601-54.625

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			0804_FCC465Instructions_100411.doc	Yes	Yes	Fillable Fileable
Form	FCC Form 465	Rural Health Care Universal Service Mechanism	0804_FCC465_100411.xls	Yes	Yes	Fillable Fileable Signable
Instruction			0804_FCC466Instructions_100411.doc	Yes	Yes	Fillable Fileable
Form	FCC Form 466	Funding Request and Certification Form	0804_FCC466_100411.xls	Yes	Yes	Fillable Fileable Signable
Instruction			0804_FCC466AInstructions_100411.doc	Yes	Yes	Fillable Fileable
Form	FCC Form 466-A	Internet Service Funding Request and Certification Form	0804_FCC466A_100411.xls	Yes	Yes	Fillable Fileable Signable
Instruction			0804_FCC467Instructions_100411.doc	Yes	Yes	Fillable Fileable
Form	FCC Form 467	Connection Certification	0804_FCC467_100411.xls	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,250

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	24,448	-35,016	59,464
Annual IC Time Burden (Hours)	28,898	-38,570	67,468
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.