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⚠️ Notice: This information collection may be referencing outdated material.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 500 FCC Forms 479, 486 and 500 (state, local or tribal entities) Form
0853 Instructions FCC Form 500 (FY2015 and earlier) 10 6 16.docx Instruction
FCC Form 500 Form Table (FY2016 and later) (10 7 16) .docx Other-Screenshot
FCC 500 Funding Commitment Adjustment Request Form 0853 FCC Form 500 (FY 2015 and earlier) 10 6 16.doc Form

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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54.508(c) 47 CFR 54.520 47 CFR 54.507(d) 47 CFR 54.513 47 CFR 54.516

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC 500	Funding Commitment Adjustment Request Form	0853 FCC Form 500 (FY 2015 and earlier) 10 6 16.doc	Yes	Yes	Fillable Fileable Signable
Instruction			0853 Instructions FCC Form 500 (FY2015 and earlier) 10 6 16.docx	Yes	Yes	Fillable Printable
Other-Screenshot			FCC Form 500 Form Table (FY2016 and later) (10 7 16) .docx	Yes	Yes	Fillable Fileable Signable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 31,850	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 65 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	31,850	-6,250	-7,250	45,350
Annual IC Time Burden (Hours)	29,288	-17,599	-5,438	52,325
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.