Information Collection

Universal Service - Rural Health Care Program

IC 31049 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⚠️ Notice: This information collection may be referencing outdated material.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
0804_Attachment 1 - Community Mental Health Center Checklist_062813.docx	Other-Checklist
0804_Attachment 2 - Telecom Program Invoice Template_062813.xls	Other-Excel spreadsheet
0804_Attachment 3 - RHC Pilot Program Invoice Template_062813.xls	Other-Excel spreadsheet
0804_Attachment 4 - FCC 465 Attachment Spreadsheet_062813.xls	Other-Excel spreadsheet
0804_Attachment 5 - Letter of Agency Template_062813.doc	Other-Template
0804_Attachment 6 - Transfer of Letter of Agency Template_062813.docx	Other-Template
0804_Attachment 7 - FCC 466-A Attachment Spreadsheet_062813.xls	Other-Excel spreadsheet
0804_Attachment 8 - Network Cost Worksheet_062813.xls	Other-Excel worksheet

IC Title:

Universal Service - Rural Health Care Program

Agency IC Tracking Number:

WCB

Is this a Common Form? No

IC Status: Unchanged

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Template	0804_Attachment 6 - Transfer of Letter of Agency Template_062813.docx	Yes	Yes	Fillable Fileable Signable
Other-Excel spreadsheet	0804_Attachment 7 - FCC 466-A Attachment Spreadsheet_062813.xls	Yes	Yes	Fillable Fileable Signable
Other-Excel worksheet	0804_Attachment 8 - Network Cost Worksheet_062813.xls	Yes	Yes	Fillable Fileable Signable
Other-Excel spreadsheet	0804_Attachment 3 - RHC Pilot Program Invoice Template_062813.xls	Yes	Yes	Fillable Fileable Signable
Other-Excel spreadsheet	0804_Attachment 4 - FCC 465 Attachment Spreadsheet_062813.xls	Yes	Yes	Fillable Fileable Signable
Other-Template	0804_Attachment 5 - Letter of Agency Template_062813.doc	Yes	Yes	Fillable Fileable Signable
Other-Checklist	0804_Attachment 1 - Community Mental Health Center Checklist_062813.docx	Yes	Yes	Fillable Fileable Signable
Other-Excel spreadsheet	0804_Attachment 2 - Telecom Program Invoice Template_062813.xls	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: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	18,015	18,015
Annual IC Time Burden (Hours)	21,847	21,847
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.