Federal Government

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⚠️ Notice: This information collection may be referencing outdated material.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 Federal Government Form
Attachment 10 - Community Mental Health Center (CMHC) Checklist.docx Other-CMHC Checklist
Attachment 11 - Post-Commitment Request Form (004) 8.17.docx Other-Post Commitment Request Form
FCC Form 460 Description of Eligibility and Registration Attachment 9 - Description of Eligibility and Registration - FCC Form 460.docx Form

Information Collection (IC) Details

IC Title:	Federal Government	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:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 460	Description of Eligibility and Registration	Attachment 9 - Description of Eligibility and Registration - FCC Form 460.docx	Yes	Yes	Fillable Fileable Signable
Other-CMHC Checklist			Attachment 10 - Community Mental Health Center (CMHC) Checklist.docx	Yes	Yes	Fillable Printable
Other-Post Commitment Request Form			Attachment 11 - Post-Commitment Request Form (004) 8.17.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: 2,434	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	11,541	2,201	9,340
Annual IC Time Burden (Hours)	66,116	8,340	57,776
Annual IC Cost Burden (Dollars)	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.