Universal Service - Rural Health Care Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FCC Form 467 RHC, Telecommunications Program, Connection Certification Form (FY2020+)	Form and Instruction	Modified	Available
Form FCC Form 462 RHC, HCFP, Description of Request for Funding (FY2020+)	Form and Instruction	Modified	Available
Form FCC Form 461 RHC, HCFP, Description of Request for Services (FY2021+)	Form and Instruction	Modified	Available
Form FCC Form 466 RHC, Telecommunications Program, Description of Request for Funding (FY2021+)	Form and Instruction	Modified	Available
Form FCC Form 466 RHC, Telecommunications Program Description of Request for Funding (FY2020)	Form and Instruction	Modified	Repair queued
Form FCC Form 465 RHC, Telecommunications Program Description of Eligibility and Request for Services (FY 2021+)	Form and Instruction	Modified	Available
Form FCC Form 465 RHC, Telecommunications Program, Description of Eligibility and Request for Services (FY2020)	Form and Instruction	Modified	Available
Form FCC Form 463 RHC, HCFP, Description of Request for Funding Disbursement (FY2021+)	Form and Instruction	Modified	Available
Form FCC Form 463 RHC, HCFP, Description of Request for Funding Disbursement (FY2020)	Form and Instruction	Modified	Available
Form FCC Form 461 RHC, HFCP, Description of Request for Services (FY2020)	Form and Instruction	Modified	Available
Form FCC Form 460 RHC, HCFP, Description of Eligibility and Registration	Form and Instruction	Modified	Available
Revised Supporting Statement 05.22.20 (final version).docx	Supporting Statement A	Uploaded 2020-05-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, Telecommunications Program, Connection Certification Form (FY2020+)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, HCFP, Description of Request for Funding (FY2020+)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, HCFP, Description of Request for Services (FY2021+)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, Telecommunications Program, Description of Request for Funding (FY2021+)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, Telecommunications Program Description of Request for Funding (FY2020)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, Telecommunications Program Description of Eligibility and Request for Services (FY 2021+)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, Telecommunications Program, Description of Eligibility and Request for Services (FY2020)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, HCFP, Description of Request for Funding Disbursement (FY2021+)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, HCFP, Description of Request for Funding Disbursement (FY2020)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, HFCP, Description of Request for Services (FY2020)
31049	Universal Service - Rural Health Care Program	Form and Instruction	Modified	RHC, HCFP, Description of Eligibility and Registration
207576	Universal Service - Rural Health Care Program	Other-Invoice Form (FY2020)	Modified
199666	Universal Service - Rural Health Care Program	Other-Post Commitment Form (FY2021)	Modified

ICR Details

OMB Control No: 3060-0804	ICR Reference No: 202002-3060-020
Status: Historical Active	Previous ICR Reference No: 201904-3060-023
Agency/Subagency: FCC	Agency Tracking No: WCB
Title: Universal Service - Rural Health Care Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/22/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/07/2020
Terms of Clearance: Supporting statement updated during review.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2023	36 Months From Approved	07/31/2022
Responses	93,687	0	117,042
Time Burden (Hours)	382,741	0	275,090
Cost Burden (Dollars)	0	0	0

---

Abstract: The FCC seeks approval to: (1) extend some of the existing information collection requirements for the Healthcare Connect Fund and Telecommunications (Telecom) Programs; (2) revise some of the information collection requirements for the Healthcare Connect Fund and Telecom Programs and (3) add some new information collection requirements applicable to both the Healthcare Connect Fund Program and the Telecom Program as a result of the 2019 Promoting Telehealth Report and Order. The FCC also seeks approval to reformat and revise the Telecom Program Invoice Template and create a new Post-Commitment Request Form consistent with the changes adopted in the 2019 Promoting Telehealth Report and Order and to promote transparency into the RHC Program procedures and requirements.

---

Authorizing Statute(s): US Code: 47 USC 201 - 205 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 154(i) - 154(j) Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 214 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 254 Name of Law: Telecommunications Act of 1996, as amended
   US Code: 47 USC 151 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 403 Name of Law: Communications Act of 1934, as amended
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3060-AI85	Final or interim final rulemaking	84 FR 54952	10/11/2019

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 5430	01/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 19475	04/07/2020
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Universal Service - Rural Health Care Program
Universal Service - Rural Health Care Program	FCC Form 466, FCC Form 466, FCC Form 460, FCC Form 463, FCC Form 463, FCC Form 461, FCC Form 465, FCC Form 461, FCC Form 462, FCC Form 467, FCC Form 465	RHC, HCFP, Description of Eligibility and Registration ,   RHC, HFCP, Description of Request for Services (FY2020) ,   RHC, HCFP, Description of Request for Funding Disbursement (FY2020) ,   RHC, HCFP, Description of Request for Funding Disbursement (FY2021+) ,   RHC, Telecommunications Program, Description of Eligibility and Request for Services (FY2020) ,   RHC, Telecommunications Program Description of Eligibility and Request for Services (FY 2021+) ,   RHC, Telecommunications Program Description of Request for Funding (FY2020) ,   RHC, Telecommunications Program, Description of Request for Funding (FY2021+) ,   RHC, HCFP, Description of Request for Services (FY2021+) ,   RHC, HCFP, Description of Request for Funding (FY2020+) ,   RHC, Telecommunications Program, Connection Certification Form (FY2020+)
Universal Service - Rural Health Care Program

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	93,687	117,042	0	4,401	-27,756	0
Annual Time Burden (Hours)	382,741	275,090	0	93,771	13,880	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Commission is reporting program changes/increases to the total number of annual responses of +4,401 and to the total annual burden hours of +93,771. These program changes are due to the addition of information collection requirements applicable to both the Healthcare Connect Fund and Telecom Programs adopting the reforms in the 2019 Promoting Telehealth Report and Order. The Commission is also reporting adjustments/ decreases of -9,820 to the total number of unique respondents and to the total number of annual responses of -27,756, as well as an adjustment/increase to the total burden hours of +13,880. These adjustments are due to a downward correction to the number of unique respondents and updates to the number of annual responses for the Telecom and Healthcare Connect Fund Programs since the last submission.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/07/2020

---