FCC Form 497 and instructions - individuals or households

Lifeline Reform and Modernization, Telecommunications Carriers Eligible for Universal Service Support, Connect America Fund

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0819 can be found here:

Documents and Forms

Document Name Document Type
Form FCC Form 497 FCC Form 497 and instructions - individuals or households Form and Instruction
FCC Form 497 Lifeline Worksheet 0819_FCC497_090412.docx Form and Instruction

Information Collection (IC) Details

IC Title:	FCC Form 497 and instructions - individuals or households	Agency IC Tracking Number:	WCB

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54.400 - 54.707 47 CFR 54.202 47 CFR 54.410(f) 47 CFR 54.416(b) 47 CFR 54.422(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FCC Form 497	Lifeline Worksheet	0819_FCC497_090412.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 940	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 35 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-11,280	11,280
Annual IC Time Burden (Hours)	-28,200	28,200
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.