Universal Service - Rural Health Care Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FCC Form 467 Connection Certification	Form	New	Available
Form FCC Form 466-A Internet Service Funding Request and Certification Form	Form	New	Available
Form FCC Form 466 Funding Request and Certification Form	Form	New	Available
Form FCC Form 465 Description of Services Requested & Certification Form	Form	New	Available
Form FCC Form 463 Healthcare Connect Fund Invoice and Request for Disbursement Form	Form	New	Available
Form FCC Form 462 Healthcare Conect Fund Funding Request Form	Form	Modified	Available
Form FCC Form 461 Healthcare Connect Fund Request for Services Form	Form	Modified	Available
Form FCC Form 460 Eligibility and Registration Form	Form	Modified	Available
0804_SS_062813.docx	Supporting Statement A	Uploaded 2013-06-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
31049	Universal Service - Rural Health Care Program	Other-Checklist	Modified
207576	Universal Service - Rural Health Care Program	Form	New	Connection Certification
207576	Universal Service - Rural Health Care Program	Form	New	Internet Service Funding Request and Certification Form
207576	Universal Service - Rural Health Care Program	Form	New	Funding Request and Certification Form
207576	Universal Service - Rural Health Care Program	Form	New	Description of Services Requested & Certification Form
207576	Universal Service - Rural Health Care Program	Instruction	New
207576	Universal Service - Rural Health Care Program	Form	New	Healthcare Connect Fund Invoice and Request for Disbursement Form
199666	Universal Service - Rural Health Care Program	Form	Modified	Healthcare Conect Fund Funding Request Form
199666	Universal Service - Rural Health Care Program	Form	Modified	Healthcare Connect Fund Request for Services Form
199666	Universal Service - Rural Health Care Program	Form	Modified	Eligibility and Registration Form
199666	Universal Service - Rural Health Care Program	Other-Template	Modified

ICR Details

OMB Control No: 3060-0804	ICR Reference No: 201306-3060-006
Status: Historical Active	Previous ICR Reference No: 201302-3060-006
Agency/Subagency: FCC	Agency Tracking No: WCB
Title: Universal Service - Rural Health Care Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/22/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/01/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved	11/30/2014
Responses	54,041	0	48,895
Time Burden (Hours)	65,539	0	57,796
Cost Burden (Dollars)	0	0	0

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Abstract: The Commission is submitting this revision which is utilized for the rural health care (RHC) support mechanism of the FCC's universal service fund (USF). The purpose of the revision is to seek OMB approval for: 1) new information collection requirements associated with the Healthcare Connect Fund, a new RHC fund created by the Rural Helath Care Support Mechanism Report and Order, FCC 12-150; 2) new innformation collection requirments associated with a skilled nursing facilities pilot program (SNF pilot); 3) revisions to the annual reporting requirement for participants in the FCC's existing rural health care Pilot Program (created in 2006); and 4) extend the information collection requirements forthe existing RHC programs (the Telecommunications Program and the Internet Access Program , as well as the 2006 Pilot Program.)

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Authorizing Statute(s): 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: Telecommunications Act of 1996, as amended
   US Code: 47 USC 403 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 151 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:
3060-AJ85	Final or interim final rulemaking	78 FR 13936	03/01/2013

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 19479	04/01/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 39286	07/01/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Universal Service - Rural Health Care Program
Universal Service - Rural Health Care Program	FCC Form 463, FCC Form 465, FCC Form 466, FCC Form 466-A, FCC Form 467	Healthcare Connect Fund Invoice and Request for Disbursement Form ,   Description of Services Requested & Certification Form ,   Funding Request and Certification Form ,   Internet Service Funding Request and Certification Form ,   Connection Certification
Universal Service - Rural Health Care Program	FCC Form 460, FCC Form 461, FCC Form 462	Eligibility and Registration Form ,   Healthcare Connect Fund Request for Services Form ,   Healthcare Conect Fund Funding Request Form

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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	54,041	48,895	0	5,146	0	0
Annual Time Burden (Hours)	65,539	57,796	0	7,743	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The Commission is reporting a 7,743 hour program change increase for this revision. The program change increase is due to the creation of four new FCC Forms 460, 461, 462 and 463.

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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: 07/01/2013

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