FCC Forms 555 and 481

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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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 %

	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

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.