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Universal Service - Rural Health Care Program
Universal Service - Rural Health Care Program
OMB: 3060-0804
IC ID: 207576
OMB.report
FCC
OMB 3060-0804
ICR 201409-3060-006
IC 207576
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0804 can be found here:
2024-07-08 - Revision of a currently approved collection
2023-10-25 - Revision of a currently approved collection
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
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:
Document Type
Form No.
Form Name
Instrument File
URL
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
Form
FCC 465
Health Care Providers Universal Service - Description of Services Requested & Certification Form
0804 2014 FCC Form 465_073014.pdf
Yes
Yes
Fillable Fileable Signable
Instruction
0804 2014 FCC Form 465 Instructions_073014.pdf
Yes
Yes
Printable Only
Form
FCC 466
Health Care Providers Universal Service - Funding Request and Certification Form
0804 2014 FCC Form 466_073014.pdf
Yes
Yes
Fillable Fileable Signable
Instruction
0804 2014 FCC Form 466 Instructions_073014.pdf
Yes
Yes
Printable Only
Form
FCC 467
Health Care Providers Universal Service - Connection Certification
0804 2014 FCC Form 467_073014.pdf
Yes
Yes
Fillable Fileable Signable
Instruction
0804 2014 FCC Form 467 Instructions_073014.pdf
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
18,011
0
0
0
0
18,011
Annual IC Time Burden (Hours)
21,845
0
0
0
0
21,845
Annual IC Cost Burden (Dollars)
0
0
0
0
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.