Universal Service - Rural Health Care Program

⚠️ Notice: This information collection may be referencing outdated material.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 1 - Copy of Network Cost Worksheet Excel Template.xls Other-Network Cost Worksheet _Templa
Attachment 2 - RHCPP-Sample-Project-Coordinator-Certification.doc Other-Project Coordinator Certificat
Attachment 3 - RHCPP-Sample-Vendor-Certification.doc Other-Vendor Certification Letter

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-Network Cost Worksheet _Template	Copy of Attachment 1 - Copy of Network Cost Worksheet Excel Template.xls	Yes	Yes	Fillable Fileable Signable
Other-Project Coordinator Certification Letter	Attachment 2 - RHCPP-Sample-Project-Coordinator-Certification.doc	Yes	Yes	Fillable Fileable Signable
Other-Vendor Certification Letter	Attachment 3 - RHCPP-Sample-Vendor-Certification.doc	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: State, Local, and Tribal Governments

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	-222	-6,714	45,950
Annual IC Time Burden (Hours)	91,696	-200	-4,590	96,486
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.