Information Collection

Universal Service - Rural Health Care Program

IC 31049 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

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	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

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.