Information Collection

FCC Form 497

IC 218852 under ICR 201804-3060-015 · 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.