Universal Service - Rural Health Care Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 467 RHCTP Description of Request for Fundiing Disbursement	Form	Modified	Available
Form Form 466 RHCTP Description of Request for Funding	Form	Modified	Available
Form Form 465 RHCTP Description of Eligibility and Request for Services	Form	Modified	Available
Form Form 463 RHCP Description of Request for Funding Disbursement	Form	Modified	Available
Form Form 462 RHCP Description of Request for Funding	Form	Modified	Available
Form Form 461 RHCP Description of Request for Services	Form	Modified	Available
Form FCC 460 RHCP Description of Eligibility and Registration	Form	Modified	Available
Form Form 476 HCPUS Connection Certification	Form and Instruction	Modified	Available
Form Form 466 HCPUS Funding Request and Certification Form	Form and Instruction	Modified	Available
Form Form 465 HCPUS Description of Services Requested and Certification Form	Form and Instruction	Modified	Available
Form Form 463 RHC HCF Invoice and Request for Disbursement Form	Form and Instruction	Modified	Available
Form Form 462 RHCUS HCF Description of Funding	Form and Instruction	Modified	Available
Form Form 461 RHCP Description of Request for Services	Form and Instruction	Modified	Available
Form Form 460 RHCP Description of Eligibility and Registration	Form and Instruction	Modified	Available
RHC Supporting Statement 0804 (final 0716).docx	Supporting Statement A	Uploaded 2016-07-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
31049	Universal Service - Rural Health Care Program	Other-Certification	Modified
207576	Universal Service - Rural Health Care Program	Form	Modified	RHCTP Description of Request for Fundiing Disbursement
207576	Universal Service - Rural Health Care Program	Form	Modified	RHCTP Description of Request for Funding
207576	Universal Service - Rural Health Care Program	Form	Modified	RHCTP Description of Eligibility and Request for Services
207576	Universal Service - Rural Health Care Program	Form	Modified	RHCP Description of Request for Funding Disbursement
207576	Universal Service - Rural Health Care Program	Form	Modified	RHCP Description of Request for Funding
207576	Universal Service - Rural Health Care Program	Form	Modified	RHCP Description of Request for Services
207576	Universal Service - Rural Health Care Program	Form	Modified	RHCP Description of Eligibility and Registration
199666	Universal Service - Rural Health Care Program	Form and Instruction	Modified	HCPUS Connection Certification
199666	Universal Service - Rural Health Care Program	Form and Instruction	Modified	HCPUS Funding Request and Certification Form
199666	Universal Service - Rural Health Care Program	Form and Instruction	Modified	HCPUS Description of Services Requested and Certification Form
199666	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC HCF Invoice and Request for Disbursement Form
199666	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHCUS HCF Description of Funding
199666	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHCP Description of Request for Services
199666	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHCP Description of Eligibility and Registration

ICR Details

OMB Control No: 3060-0804	ICR Reference No: 201606-3060-028
Status: Historical Active	Previous ICR Reference No: 201409-3060-006
Agency/Subagency: FCC	Agency Tracking No: WCB
Title: Universal Service - Rural Health Care Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/07/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/22/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	36 Months From Approved	09/30/2016
Responses	137,846	0	54,041
Time Burden (Hours)	289,454	0	65,539
Cost Burden (Dollars)	0	0	0

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Abstract: The FCC seeks approval to: (1) eliminate the information requirement for the Internet Access Program; (2) extend some of the existing collection requirements for the Healthcare Connect Fund, the Skilled Nursing Facilities Pilot Program, and the Telecommunications Program; and (3) revise some of the existing information collection requirements for the Healthcare Connect Fund and the Telecommunications Programs.

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Authorizing Statute(s): US Code: 47 USC 154(i) - 154(j) Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 201 - 205 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 214 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 254 Name of Law: Telecommunications Act of 1996, as amended
   US Code: 47 USC 151 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 403 Name of Law: Communications Act of 1934, as amended
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3060-AI85	Final or interim final rulemaking	78 FR 13936	03/01/2013

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 27444	05/05/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 47389	07/21/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Universal Service - Rural Health Care Program
Universal Service - Rural Health Care Program	Form 460, Form 461, Form 463, Form 466, Form 476, Form 462, Form 465	RHCP Description of Eligibility and Registration ,   RHCP Description of Request for Services ,   RHCUS HCF Description of Funding ,   RHC HCF Invoice and Request for Disbursement Form ,   HCPUS Description of Services Requested and Certification Form ,   HCPUS Funding Request and Certification Form ,   HCPUS Connection Certification
Universal Service - Rural Health Care Program	Form 461, Form 462, Form 463, Form 465, Form 467, FCC 460, Form 466	RHCP Description of Eligibility and Registration ,   RHCP Description of Request for Services ,   RHCP Description of Request for Funding ,   RHCP Description of Request for Funding Disbursement ,   RHCTP Description of Eligibility and Request for Services ,   RHCTP Description of Request for Funding ,   RHCTP Description of Request for Fundiing Disbursement

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	137,846	54,041	0	30,408	53,397	0
Annual Time Burden (Hours)	289,454	65,539	0	57,151	166,764	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Commission is reporting program changes/increases of +8,484 to the total number of unique respondents, to the total number of annual responses of +30,408, and to the total annual burden hours of +57,151. These program changes/increases are primarily due to changes to the Telecommunications Program forms to harmonize the application processes for this program with the Healthcare Connect Fund Program and are intended to make the RHC Program information requests consistent between the programs, to the extent possible. These program changes/increases are also due to recently enacted legislation signed by the President on June 22, 2016 (See Frank R. Lautenberg Chemical Safety for the 21st Century Act, Title II – Rural Healthcare Connectivity, Pub. L. No. 114-182 (2016)), resulting in the elimination of the information collection requirements associated with the SNF Pilot Program and the addition of another eligible health care provider category. The Commission is reporting adjustments/increases to this information collection. The total number of annual responses increased by +53,397. Of the + 53,397 total annual responses, 2,595 are adjustments to the total annual responses which are due to the Commission correcting a miscalculation in its previous submission to OMB. The total annual burden hours increased by +166,764. These adjustments/increases are due to the overall evolvement of the Healthcare Connect Fund, its impact on the affected stakeholders associated with this information collection, and the recent legislation including SNFs as an eligible health care provider under the RHC Program.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/22/2016

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