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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment 1 - (11.8.19) Post-Commitment Request Form - Effective FY 2021 (4.7.20).docx Other-Post Commitment Form (FY2021)
Attachment 1 - (11.8.19) Post-Commitment Request Form - Effective upon OMB approval (4.7.20).docx Other-Post Commitment Form
Attachment 3 - RHC CMHC-Certification-Checklist (4.3.20).docx Other-CMHC - Certification Checklist

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 - 54.633

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Post Commitment Form (FY2021)	Attachment 1 - (11.8.19) Post-Commitment Request Form - Effective FY 2021 (4.7.20).docx	Yes	Yes	Fillable Fileable Signable
Other-Post Commitment Form	Attachment 1 - (11.8.19) Post-Commitment Request Form - Effective upon OMB approval (4.7.20).docx	Yes	Yes	Fillable Fileable Signable
Other-CMHC - Certification Checklist	Attachment 3 - RHC CMHC-Certification-Checklist (4.3.20).docx	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,498	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	31,229	1,467	-9,252	39,014
Annual IC Time Burden (Hours)	127,580	31,257	4,626	91,697
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.