Information Collection

Universal Service - Rural Health Care Program

IC 199666 under ICR 201606-3060-028 · OMB 3060-0804.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0804 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.