Information Collection

Individuals or Households

IC 218852 under ICR 202004-3060-007 · OMB 3060-0819.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0819 can be found here:

Documents and Forms

Document Name Document Type
Form FCC Form 5629 Individuals or Households Form
Lifeline Form Change Memo (01.27).docx Other-Form Change Memo
FCC Form 5629 Lifeline Application Universal Form LI_App_UniversalForm5629-Jan2020_v3.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Individuals or Households	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 54.201-54.207 47 CFR 54.400-54.423

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 5629	Lifeline Application Universal Form	LI_App_UniversalForm5629-Jan2020_v3.pdf		Yes	Yes	Fillable Fileable Signable
Other-Form Change Memo			Lifeline Form Change Memo (01.27).docx		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title: FCC/WCB - 1, Lifeline Program	FR Citation: 82 FR 38686

Number of Respondents: 9,167,887	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	10,051,118	-2,521,634	2,413,858	10,158,894
Annual IC Time Burden (Hours)	4,265,927	-2,692,797	1,472,404	5,486,320
Annual IC Cost Burden (Dollars)	468,750	0	0	468,750

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.