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⚠️ Notice: This information collection may be referencing outdated material.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
Form Form 465 Universal Service - Rural Health Care Program Form and Instruction
Form 460 RHCP Description of Eligibility and Registration FCC-Form-460-Form-and-Instructions.pdf Form and Instruction
Form 461 RHCP Description of Request for Services FCC-Form-461-Form-and-Instructions.pdf Form and Instruction
Form 462 RHCUS HCF Description of Funding FCC-Form-462-Form-and-Instructions.pdf Form and Instruction
Form 463 RHC HCF Invoice and Request for Disbursement Form FCC-Form-463-Form-and-Instructions.pdf Form and Instruction
Form 465 HCPUS Description of Services Requested and Certificatio FCC-Form-465-Form-and-Instructions.pdf Form and Instruction
Form 466 HCPUS Funding Request and Certification Form FCC-Form-466-Form-and-Instructions.pdf Form and Instruction
Form 476 HCPUS Connection Certification FCC-Form-467-Form-and-Instructions.pdf Form and Instruction

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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54.600 - 54.680

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 465	HCPUS Description of Services Requested and Certification Form	FCC-Form-465-Form-and-Instructions.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form 466	HCPUS Funding Request and Certification Form	FCC-Form-466-Form-and-Instructions.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form 476	HCPUS Connection Certification	FCC-Form-467-Form-and-Instructions.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form 460	RHCP Description of Eligibility and Registration	FCC-Form-460-Form-and-Instructions.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form 461	RHCP Description of Request for Services	FCC-Form-461-Form-and-Instructions.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form 462	RHCUS HCF Description of Funding	FCC-Form-462-Form-and-Instructions.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form 463	RHC HCF Invoice and Request for Disbursement Form	FCC-Form-463-Form-and-Instructions.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,494	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	45,948	10,136	17,797	18,015
Annual IC Time Burden (Hours)	96,484	19,050	55,587	21,847
Annual IC Cost Burden (Dollars)	0	0	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.