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⚠️ Notice: This information collection may be referencing outdated material.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: Unchanged

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	Previously Approved
Annual Number of Responses for this IC	11,541	11,541
Annual IC Time Burden (Hours)	66,116	66,116
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.