Information Collection

FCC Form 497

IC 218852 under ICR 201606-3060-029 · OMB 3060-0819.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0819 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 497 Lifeline Worksheet FCC Form 497	Form and Instruction
Lifeline Form 497 Field Descriptions_Final-Clean_7-12-16.docx	Other-Form 497 Field Descriptions
Form 497 Lifeline Worksheet FCC Form 497 Instructions_Final_7-11-16.docx	Form and Instruction

IC Title:

FCC Form 497

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54.400-54.707 47 CFR 54

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Form 497 Field Descriptions					Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form 497				Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,581,130

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	11,978,120	-2,292,841	-1,000,000	15,270,961
Annual IC Time Burden (Hours)	6,742,206	-3,616,251	-673,942	11,032,399
Annual IC Cost Burden (Dollars)	468,750	0	468,750	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.

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