Universal Service - Rural Health Care 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⚠️ Notice: This information collection may be referencing outdated material.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 463 Universal Service - Rural Health Care Program Form
0804_Attachment 18_FCC Form 463 Instructions_062813.docx Instruction
0804_Attachment 20_FCC Form 465 Instructions_06281`3.pdf Instruction
0804_Attachment 22_FCC Form 466 Instructions_062813.pdf Instruction
0804_Attachment 24_FCCForm 466-A Instructions_062813.pdf Instruction
0804_Attachment 26_FCC Form 467 Instructions_062813.pdf Instruction
FCC Form 463 Healthcare Connect Fund Invoice and Request for Disburse 0804_Attachment 17_FCC Form 463_062813.pdf Form
FCC Form 465 Description of Services Requested & Certification Form 0804_Attachment 19_ FCC Form 465_062813.pdf Form
FCC Form 466 Funding Request and Certification Form 0804_Attachment 21_FCC Form 466_062813.pdf Form
FCC Form 466-A Internet Service Funding Request and Certification Form 0804_Attachment 23_FCC Form 466-A_062813.pdf Form
FCC Form 467 Connection Certification 0804_Attachment 25_FCC Form 467_062813.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Universal Service - Rural Health Care Program	Agency IC Tracking Number:	WCB

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR Part 54 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 463	Healthcare Connect Fund Invoice and Request for Disbursement Form	0804_Attachment 17_FCC Form 463_062813.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			0804_Attachment 18_FCC Form 463 Instructions_062813.docx	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 465	Description of Services Requested & Certification Form	0804_Attachment 19_ FCC Form 465_062813.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			0804_Attachment 20_FCC Form 465 Instructions_06281`3.pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 466	Funding Request and Certification Form	0804_Attachment 21_FCC Form 466_062813.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			0804_Attachment 22_FCC Form 466 Instructions_062813.pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 466-A	Internet Service Funding Request and Certification Form	0804_Attachment 23_FCC Form 466-A_062813.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			0804_Attachment 24_FCCForm 466-A Instructions_062813.pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 467	Connection Certification	0804_Attachment 25_FCC Form 467_062813.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			0804_Attachment 26_FCC Form 467 Instructions_062813.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,666	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18,011	18,011
Annual IC Time Burden (Hours)	21,845	21,845
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.