Information Collection

FCC Forms 555 and 481

IC 218853 under ICR 201711-3060-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 FCC 555 FCC Forms 555 and 481	Form
FCC-Form-481-Instructions 8_9.pdf	Instruction
FCC-Form-481-Template 8_9.pdf	Other-FCC 481 - Template
FCC 555 Description of Services Requested and Certification - Fi 3060-0819 Lifeline Form 555 Field Descriptions_Clean 042717.docx	Form

IC Title:

FCC Forms 555 and 481

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 54.101

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	FCC 555	Description of Services Requested and Certification - Field Descriptions	3060-0819 Lifeline Form 555 Field Descriptions_Clean 042717.docx	Yes	Yes	Fillable Fileable Signable
Instruction			FCC-Form-481-Instructions 8_9.pdf	Yes	Yes	Fillable Printable
Other-FCC 481 - Template			FCC-Form-481-Template 8_9.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: FCC/WCB "Lifeline Program"

FR Citation: 82 FR 38686

Number of Respondents: 10,047,179

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11,977,062	312,830	11,664,232
Annual IC Time Burden (Hours)	5,514,286	-559,790	6,074,076
Annual IC Cost Burden (Dollars)	468,750	0	468,750

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.