Information Collection

Universal Service - Rural Health Care Program

IC 207576 under ICR 201904-3060-023 · OMB 3060-0804.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0804 can be found here:

Documents and Forms

Document Name Document Type
Copy of Attachment 4 - Copy of RHC Pilot Program_Invoice Template.xlsm Other-Pilot Program Invoice Template
Attachment 5 - RHC CMHC-Certification-Checklist.pdf Other-CMHC - Certification - Checkli
Copy of Attachment 6 - Copy of RHC Telecom Program_Invoice Template.xls Other-RHC - Telecom Program Invoice

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Universal Service - Rural Health Care Program	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 54.600 - 54.680

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Pilot Program Invoice Template	Copy of Attachment 4 - Copy of RHC Pilot Program_Invoice Template.xlsm	Yes	Yes	Fillable Fileable Signable
Other-CMHC - Certification - Checklist	Attachment 5 - RHC CMHC-Certification-Checklist.pdf	Yes	Yes	Fillable Fileable Signable
Other-RHC - Telecom Program Invoice Template	Copy of Attachment 6 - Copy of RHC Telecom Program_Invoice Template.xls	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,771	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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	39,014	-223	-6,711	45,948
Annual IC Time Burden (Hours)	91,697	-201	-4,586	96,484
Annual IC Cost Burden (Dollars)	0	0	0	0

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.