Information Collection

Federal Government

IC 241112 under ICR 202008-3060-005 · OMB 3060-1271.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.