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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form FCC Form 465 Universal Service - Rural Health Care Program/Rural Health Care Pilot Program Form
FCC Form 465 Description of Services Requested and Certification Form 0804_FCC465_NonSubstantiveChange_013113.rtf Form
FCC Form 466 Funding Request and Certification Form 0804_FCC466_NonSubstantiveChange_013113.rtf Form
FCC Form 466-A Internet Service Funding Request and Certification Form 0804_FCC466_A_NonSubstantiveChange_013113.rtf Form
FCC Form 467 Connection Certification 0804_FCC467_NonSubstantiveChange_013113.rtf Form

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 465	Description of Services Requested and Certification Form	0804_FCC465_NonSubstantiveChange_013113.rtf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 466	Funding Request and Certification Form	0804_FCC466_NonSubstantiveChange_013113.rtf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 466-A	Internet Service Funding Request and Certification Form	0804_FCC466_A_NonSubstantiveChange_013113.rtf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 467	Connection Certification	0804_FCC467_NonSubstantiveChange_013113.rtf	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: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 98 %

	Approved	Previously Approved
Annual Number of Responses for this IC	24,447	24,447
Annual IC Time Burden (Hours)	28,898	28,898
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.