Information Collection

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

IC 188198 under ICR 201110-3060-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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
2011 Instruct - Changes (10-11-11)(REDLINE)(Form 499-A).doc forms.universalservice.org Instruction
2012 Instruct - Changes (10-11-11)(REDLINE)(Form 499-A).doc forms.universalservice.org Instruction
FCC Form 499-Q Instructions (OMB Approved Version).doc forms.universalservice.org Instruction
FCC Form 499-Q Telecommunications Reporting Worksheet FCC Form 499-Q (OMB Approved Version).pdf forms.universalservice.org Form
FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2010 R FCC Form 499-A 2011.pdf http:/forms.universalservice.org Form
FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2011 R FCC Form 499-A 2012.pdf http:/forms.universalservice.org Form

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			2011 Instruct - Changes (10-11-11)(REDLINE)(Form 499-A).doc	http://forms.universalservice.org	Yes	Yes	Fillable Fileable Signable
Instruction			2012 Instruct - Changes (10-11-11)(REDLINE)(Form 499-A).doc	http://forms.universalservice.org	Yes	Yes	Fillable Fileable Signable
Instruction			FCC Form 499-Q Instructions (OMB Approved Version).doc	http://forms.universalservice.org	Yes	Yes	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
Form	FCC Form 499-A	Telecommunications Reporting Worksheet (Reporting 2010 Revenues)	FCC Form 499-A 2011.pdf	http:/forms.universalservice.org	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 499-A	Telecommunications Reporting Worksheet (Reporting 2011 Revenues)	FCC Form 499-A 2012.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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

	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

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