FCC Form 497

Lifeline Reform and Modernization, Telecommunications Carriers Eligible for Universal Service Support, Connect America Fund

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
3060-0819 Form 497 Field Descriptions_Final-Clean_7-12-16.docx Other-FCC 497 Field Descriptions
FCC 497 Lifeline Worksheet 3060-0819 FCC Form 497 Instructions_Final_7-11-16.docx Form and Instruction

Information Collection (IC) Details

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 54.400-54.423 47 CFR 54.201-54.207

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-FCC 497 Field Descriptions			3060-0819 Form 497 Field Descriptions_Final-Clean_7-12-16.docx		Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC 497	Lifeline Worksheet	3060-0819 FCC Form 497 Instructions_Final_7-11-16.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title: FCC/WCB - 1, Lifeline Program	FR Citation: 78 FR 73535

Number of Respondents: 10,267,665	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	11,664,231	-313,889	11,978,120
Annual IC Time Burden (Hours)	6,074,075	-668,131	6,742,206
Annual IC Cost Burden (Dollars)	468,750	0	468,750

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.