FCC Form 497

Lifeline and Link Up 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⚠️ Notice: This information collection may be referencing outdated material.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 Form 497 FCC Form 497 Form and Instruction
FCC Form 497 Lifeline Worksheet FCC-Form-497.pdf Form and Instruction
FCC Form 5629 Lifeline Program Application Form FCC-Form-5629.pdf Form
FCC Form 5630 Lifeline Program Annual Recertification Form FCC-Form-5630.pdf Form
FCC Form 5631 Lifeline Program Household Worksheet FCC-Form-5631.pdf Form

Information Collection (IC) Details

IC Title:	FCC Form 497	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 54.400-54.423 47 CFR 54.201-54.207

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FCC Form 497	Lifeline Worksheet	FCC-Form-497.pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5629	Lifeline Program Application Form	FCC-Form-5629.pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5630	Lifeline Program Annual Recertification Form	FCC-Form-5630.pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5631	Lifeline Program Household Worksheet	FCC-Form-5631.pdf	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: 82 FR 38686

Number of Respondents: 8,773,921	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,158,894	66	-1,818,233	11,977,061
Annual IC Time Burden (Hours)	5,486,320	66	-28,031	5,514,285
Annual IC Cost Burden (Dollars)	468,750	0	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.