Information Collection

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

IC 188198 under ICR 201312-3060-019 · 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⚠️ Notice: This information collection may be referencing outdated material.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_FCC499A Instructions_final_022813.docx	Instruction
0855_FCC499Q_Instructions_090413.doc	Instruction
0855_2014 FCC Form 499-A Instructions (clean)_010114.docx	Instruction
0855_2014 FCC Form 499-Q Instructions (clean)_010114.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 Filin 0855_FCCForm 499Q_090413(clean).doc	Form
FCC 499-A 2014 FCC Form 499-A Telecommunications Reporting Workshe 0855_2014 FCC Form 499-A (clean)_010114.docx	Form
FCC 499-Q 2014 FCC Form 499-Q Telecommunications Reporting Workshe 0855_2014 FCC Form 499-Q (clean)_010114.docx	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 1.47 47 CFR 54.709 47 CFR 54.706 47 CFR 54.711

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
Instruction			0855_FCC499A Instructions_final_022813.docx	Yes	Yes	Fillable Fileable Signable
Instruction			0855_FCC499Q_Instructions_090413.doc	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 499-Q	Telecommunications Reporting Worksheet - Quarterly Filing for Universal Service Contributors	0855_FCCForm 499Q_090413(clean).doc	Yes	Yes	Fillable Fileable Signable
Form	FCC 499-A	2014 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2013 Revenues)	0855_2014 FCC Form 499-A (clean)_010114.docx	Yes	Yes	Fillable Fileable Signable
Instruction			0855_2014 FCC Form 499-A Instructions (clean)_010114.docx	Yes	Yes	Fillable Fileable Signable
Form	FCC 499-Q	2014 FCC Form 499-Q Telecommunications Reporting Worksheet Quarterly Filing for Universal Service Contributors	0855_2014 FCC Form 499-Q (clean)_010114.docx	Yes	Yes	Fillable Fileable Signable
Instruction			0855_2014 FCC Form 499-Q Instructions (clean)_010114.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
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.