OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Individuals or Households

IC 218852 under ICR 202012-3060-004 · OMB 3060-0819.

Documents and Forms
Document Name
Document Type
Form
Other-Form Change Memo
Other-Template Form 481
Form
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Individuals or Households WCB
 
No Modified
 
Required to Obtain or Retain Benefits
 
47 CFR 54.201-54.207 47 CFR 54.400-54.423

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
Other-Template Form 481 PRA Template Form 481 2.3.2020 (clean).docx Yes Yes Fillable Fileable Signable
Form and Instruction FCC 497 Lifeline Worksheet FCC-Form-497.pdf Yes Yes Fillable Fileable Signable

General Government Central Fiscal Operations

FCC/WCB - 1, Lifeline Program   82 FR 38686

9,167,887 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10,051,118 0 0 0 0 10,051,118
Annual IC Time Burden (Hours) 4,265,927 0 0 0 0 4,265,927
Annual IC Cost Burden (Dollars) 468,750 0 0 0 0 468,750

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.