FCC Forms 479, 486 and 500 (state, local or tribal entities)

Certification by Administrative Authority to Billed Entity Compliance with the Children's Internet Protection Act Form; Certification of Compliance with the CIPA and Technology Plan Requirements Form;

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0853 can be found here:

Documents and Forms

Document Name Document Type
Form FCC 479 FCC Forms 479, 486 and 500 (state, local or tribal entities) Form
0853 Instructions FCC Form 479_122713.docx Instruction
0853 Instructions FCC Form 486_122713.docx Instruction
0853 Instructions FCC Form 500 2013_122713.docx Instruction
FCC 479 Certification by Administrative Authority to Billed Enti 0853 FCC Form 479_122713.doc Form
FCC 486 Receipt of Service Confirmation and Children's Internet 0853 FCC Form 486_122713.doc Form
FCC 500 Funding Commitment Adjustment Request Form 0853 FCC Form 500_122713.doc Form
0853_Nonsubstantive ChangeAbstract_122713_final.doc Non-substantive changes to FCC Forms 479, 486, and 500 and Instructions IC Document

Information Collection (IC) Details

IC Title:	FCC Forms 479, 486 and 500 (state, local or tribal entities)	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 54.516 47 CFR 54.520 47 CFR 54.507(d) 47 CFR 54.513 47 CFR 54.508(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC 479	Certification by Administrative Authority to Billed Entity of Compliance with the Children's Internet Protection Act	0853 FCC Form 479_122713.doc	No		Printable Only
Instruction			0853 Instructions FCC Form 479_122713.docx	No		Printable Only
Form	FCC 486	Receipt of Service Confirmation and Children's Internet Protection Act and Technology Plan Certification Form	0853 FCC Form 486_122713.doc	Yes	Yes	Fillable Fileable
Instruction			0853 Instructions FCC Form 486_122713.docx	Yes	Yes	Fillable Fileable
Form	FCC 500	Funding Commitment Adjustment Request Form	0853 FCC Form 500_122713.doc	No		Printable Only
Instruction			0853 Instructions FCC Form 500 2013_122713.docx	No		Printable Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45,350	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 65 %

	Approved	Previously Approved
Annual Number of Responses for this IC	45,350	45,350
Annual IC Time Burden (Hours)	52,325	52,325
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Non-substantive changes to FCC Forms 479, 486, and 500 and Instructions	0853_Nonsubstantive ChangeAbstract_122713_final.doc	12/27/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.