Information Collection

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

IC 188198 under ICR 201302-3060-014 · 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⚠️ Notice: This information collection may be referencing outdated material.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
0855_Attach2_FCCForm 499-A Instructions (CLEAN VERSION)_011413.doc	Instruction
0855_Attach4_FCCForm 499-Q Instructions(CLEAN VERSION)_011413.doc	Instruction
0855_FCC499AInstructions_022513.docx	Instruction
0855_FCC499_QInstructions_022513.docx	Instruction
FCC Form 499-A 2013 Telecommunications Reporting Worksheet (Reporting 2 0855_Attach1_FCCForm499-A_(CLEAN VERSION)_011413.doc	Form
FCC Form 499-Q Telecommunications Reporting Worksheet, Quarterly Filing 0855_Attach3_FCCForm 499-Q_(CLEAN VERSION)_011413.doc	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 54.706 47 CFR 54.711 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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 499-A	2013 Telecommunications Reporting Worksheet (Reporting 2012 Revenues)	0855_Attach1_FCCForm499-A_(CLEAN VERSION)_011413.doc	Yes	Yes	Fillable Fileable Signable
Instruction			0855_Attach2_FCCForm 499-A Instructions (CLEAN VERSION)_011413.doc	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 499-Q	Telecommunications Reporting Worksheet, Quarterly Filing for Universal Service Contributors	0855_Attach3_FCCForm 499-Q_(CLEAN VERSION)_011413.doc	Yes	Yes	Fillable Fileable Signable
Instruction			0855_Attach4_FCCForm 499-Q Instructions(CLEAN VERSION)_011413.doc	Yes	Yes	Fillable Fileable Signable
Instruction			0855_FCC499AInstructions_022513.docx	Yes	Yes	Fillable Fileable Signable
Instruction			0855_FCC499_QInstructions_022513.docx	Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Business and Industry Development

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	Previously Approved
Annual Number of Responses for this IC	46,957	46,957
Annual IC Time Burden (Hours)	313,881	313,881
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.