Individuals or Households

Bridging the Digital Divide for Low-Income Consumers, Lifeline and Link Up Reform and Modernization, Telecommunications Carriers Eligible for Universal Service Support

⚠️ Notice: This information collection may be referencing outdated material.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
PRA Template Form 481 2.3.2020 (clean).docx Other-Template Form 481
FCC Form 5629 Lifeline Application Universal Form LI_App_UniversalForm5629-Jan2020_v3.pdf Form
FCC 497 Lifeline Worksheet FCC-Form-497.pdf Form and Instruction

Information Collection (IC) Details

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	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

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	Previously Approved
Annual Number of Responses for this IC	10,051,118	10,051,118
Annual IC Time Burden (Hours)	4,265,927	4,265,927
Annual IC Cost Burden (Dollars)	468,750	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.