Information Collection

Universal Service - Rural Health Care Program

IC 207576 under ICR 201409-3060-006 · OMB 3060-0804.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FCC Form 463 Healthcare Connect Fund Invoice and Request for Disbursement Form Universal Service - Rural Health Care Program	Form
Form FCC Form 465 Description of Services Requested & Certification Form Universal Service - Rural Health Care Program	Form
Form FCC Form 466 Funding Request and Certification Form Universal Service - Rural Health Care Program	Form
Form FCC Form 466-A Internet Service Funding Request and Certification Form Universal Service - Rural Health Care Program	Form
Form FCC Form 467 Connection Certification Universal Service - Rural Health Care Program	Form
Form FCC 465 Health Care Providers Universal Service - Description of Services Requested & Certification Form Universal Service - Rural Health Care Program	Form
Form FCC 466 Health Care Providers Universal Service - Funding Request and Certification Form Universal Service - Rural Health Care Program	Form
Form FCC 467 Health Care Providers Universal Service - Connection Certification 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
0804 2014 FCC Form 465 Instructions_073014.pdf	Instruction
0804 2014 FCC Form 466 Instructions_073014.pdf	Instruction
0804 2014 FCC Form 467 Instructions_073014.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
FCC 465 Health Care Providers Universal Service - Description of 0804 2014 FCC Form 465_073014.pdf	Form
FCC 466 Health Care Providers Universal Service - Funding Reques 0804 2014 FCC Form 466_073014.pdf	Form
FCC 467 Health Care Providers Universal Service - Connection Cer 0804 2014 FCC Form 467_073014.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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54.600 - 54.680

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 463	Yes	Yes	Fillable Fileable Signable
Instruction		Yes	Yes	Fillable Fileable Signable
Form	FCC Form 465	Yes	Yes	Fillable Fileable Signable
Instruction		Yes	Yes	Fillable Fileable Signable
Form	FCC Form 466	Yes	Yes	Fillable Fileable Signable
Instruction		Yes	Yes	Fillable Fileable Signable
Form	FCC Form 466-A	Yes	Yes	Fillable Fileable Signable
Instruction		Yes	Yes	Fillable Fileable Signable
Form	FCC Form 467	Yes	Yes	Fillable Fileable Signable
Instruction		Yes	Yes	Fillable Fileable Signable
Form	FCC 465	Yes	Yes	Fillable Fileable Signable
Instruction		Yes	Yes	Printable Only
Form	FCC 466	Yes	Yes	Fillable Fileable Signable
Instruction		Yes	Yes	Printable Only
Form	FCC 467	Yes	Yes	Fillable Fileable Signable
Instruction		Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	Approved	Previously Approved
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

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.

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