FCC Form 555, Annual Lifeline Eligible Telecommunications Carrier Certification Form

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⚠️ Notice: This information collection may be referencing outdated material.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 555 FCC Form 555, Annual Lifeline Eligible Telecommunications Carrier Certification Form Form and Instruction
FCC Form 555 Annual Lifeline Eligibility Telecommunications Carrier C 0819_FCC555_Revised_091412.docx Form and Instruction
FCC Form 555 Annual Lifeline Eligibility Telecommunications Carrier C 0819_FCC555_Revised_091412.docx Form and Instruction

Information Collection (IC) Details

IC Title:	FCC Form 555, Annual Lifeline Eligible Telecommunications Carrier Certification Form	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

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 555	Annual Lifeline Eligibility Telecommunications Carrier Certification Form	0819_FCC555_Revised_091412.docx		Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC Form 555	Annual Lifeline Eligibility Telecommunications Carrier Certification Form	0819_FCC555_Revised_091412.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: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 35 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-940	940
Annual IC Time Burden (Hours)	-15,040	15,040
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.