State, Local or Tribal Governments

Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-1271 can be found here:

Documents and Forms

Document Name Document Type
Form FCC Form 460 State, Local or Tribal Governments Form
FCC Form 460 Description of Eligibility and Registration 2019 FCC Form 460 for OMB submission.6.29.16.docx Form

Information Collection (IC) Details

IC Title:	State, Local or Tribal Governments	Agency IC Tracking Number:	WCB

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 460	Description of Eligibility and Registration	2019 FCC Form 460 for OMB submission.6.29.16.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: 2,433	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
Annual Number of Responses for this IC	9,340	9,340
Annual IC Time Burden (Hours)	57,775	57,775
Annual IC Cost Burden (Dollars)	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.