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⚠️ Notice: This information collection may be referencing outdated material.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
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

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: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54.600 - 54.680

Information Collection 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 %

	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

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.