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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FCC Form 467 Connection Certification	Form	Unchanged	Available
Form FCC Form 466-A Internet Service Funding Request and Certification Form	Form	Unchanged	Available
Form FCC Form 466 Funding Request and Certification Form	Form	Unchanged	Available
Form FCC Form 465 Rural Health Care Universal Service Mechanism	Form	Unchanged	Available
Form FCC Form 467 Connection Certification	Form	Modified	Available
Form FCC Form 466-A Internet Service Funding Request and Certification Form	Form	Modified	Available
Form FCC Form 466 Funding Request and Certification Form	Form	Modified	Available
Form FCC Form 465 Description of Services Requested and Certification Form	Form	Modified	Available
0804_NonSubstantive Changes_013113.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2013-01-31	Available
0804_SS_100411.doc	Supporting Statement A	Uploaded 2011-10-05	Available
0804_Attachment9_100411.xls	Supplementary Document	Uploaded 2011-10-05	Available
0804_Attachment8_100411.doc	Supplementary Document	Uploaded 2011-10-05	Available
0804_Attachment7_100411.doc	Supplementary Document	Uploaded 2011-10-05	Available
0804_Attachment6_100411.xls	Supplementary Document	Uploaded 2011-10-05	Available
0804_Attachment5_100411.docx	Supplementary Document	Uploaded 2011-10-05	Available
0804_Attachment4_100411.doc	Supplementary Document	Uploaded 2011-10-05	Available
0804_Attachment3_100411.xls	Supplementary Document	Uploaded 2011-10-05	Available
0804_Attachment2_100411.xls	Supplementary Document	Uploaded 2011-10-05	Available
0804_Attachment1_100411.pdf	Supplementary Document	Uploaded 2011-10-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
31049	Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	Form	Unchanged	Connection Certification
31049	Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	Form	Unchanged	Internet Service Funding Request and Certification Form
31049	Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	Form	Unchanged	Funding Request and Certification Form
31049	Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	Form	Unchanged	Rural Health Care Universal Service Mechanism
31049	Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	Instruction	Unchanged
199666	Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	Form	Modified	Connection Certification
199666	Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	Form	Modified	Internet Service Funding Request and Certification Form
199666	Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	Form	Modified	Funding Request and Certification Form
199666	Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	Form	Modified	Description of Services Requested and Certification Form

ICR Details

OMB Control No: 3060-0804	ICR Reference No: 201301-3060-033
Status: Historical Active	Previous ICR Reference No: 201110-3060-005
Agency/Subagency: FCC	Agency Tracking No: WCB
Title: Universal Service - Rural Health Care Program/Rural Health Care Pilot Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/04/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/31/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2014	11/30/2014	11/30/2014
Responses	48,895	0	48,895
Time Burden (Hours)	57,796	0	57,796
Cost Burden (Dollars)	0	0	0

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Abstract: The Commission is submitting this non-substantive change request for FCC Forms 465, 466, 466-A and 467. On each form, block 3 allows an applicant to indicate the year for which the applicant seeks funding. The current forms refer to funding years 2009, 2010, 2011 and 2012. Each of the forms has been updated to allow applicants to select funding years 2013, 2014 and 2015.

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Authorizing Statute(s): US Code: 47 USC 403 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 151 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 154(i) - 154(j) Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 201 - 205 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 214 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 254 Name of Law: Communications Act of 1934, as amended
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 44006	07/22/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 58810	09/22/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	FCC Form 466, FCC Form 465, FCC Form 466-A, FCC Form 467	Description of Services Requested and Certification Form ,   Funding Request and Certification Form ,   Internet Service Funding Request and Certification Form ,   Connection Certification
Universal Service - Rural Health Care Program/Rural Health Care Pilot Program	FCC Form 465, FCC Form 467, FCC Form 466, FCC Form 466-A	Rural Health Care Universal Service Mechanism ,   Funding Request and Certification Form ,   Internet Service Funding Request and Certification Form ,   Connection Certification

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	48,895	48,895	0	0	0	0
Annual Time Burden (Hours)	57,796	57,796	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/31/2013

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