Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FCC Form 460 Description of Eligibility and Registration	Form	Unchanged	Available
Form FCC Form 460 Federal Government	Form	Unchanged	Repair queued
Form FCC Form 463 Description of Request for Funding Disbursement (FY2021+)	Form	Modified	Available
Form FCC Form 463 Description of Request for Funding Disbursement	Form	Modified	Available
Form FCC Form 462 Request for Funding	Form	Modified	Available
Form FCC Form 461 Request for Services	Form	Modified	Available
COVID-19 Telehealth Request for Reimbursement Form	Form	Unchanged	Available
COVID-19 Telehealth Program Application Form	Form	Unchanged	Available
Business or other for-profit	Form	Unchanged	Repair queued
3060-0804 FCC Form 463 NSC memo final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-02-04	Repair queued
IC 1271 Non Sub Change (123120).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-12-31	Repair queued
IC 1271 Non Sub Change (122820).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-12-28	Repair queued
3060-1271_CCPP_SS_final version_08212020.docx	Supporting Statement A	Uploaded 2020-08-27	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241112	Federal Government	Form	Unchanged	Description of Eligibility and Registration
241112	Federal Government	Form	Unchanged
241112	Federal Government	Other-CMHC Checklist	Unchanged
241111	State, Local or Tribal Governments	Form	Modified	Description of Request for Funding Disbursement (FY2021+)
241111	State, Local or Tribal Governments	Form	Modified	Description of Request for Funding Disbursement
241111	State, Local or Tribal Governments	Form	Modified	Request for Funding
241111	State, Local or Tribal Governments	Form	Modified	Request for Services
241111	State, Local or Tribal Governments	Other-COVID-19, Telehealth Program, LOA	Modified
241110	Business or other for-profit	Form	Unchanged	COVID-19 Telehealth Request for Reimbursement Form
241110	Business or other for-profit	Form	Unchanged	COVID-19 Telehealth Program Application Form
241110	Business or other for-profit	Form	Unchanged
241110	Business or other for-profit	Instruction	Unchanged

ICR Details

OMB Control No: 3060-1271	ICR Reference No: 202102-3060-006
Status: Historical Active	Previous ICR Reference No: 202012-3060-017
Agency/Subagency: FCC	Agency Tracking No: WCB
Title: Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/19/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/04/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2023	10/31/2023	10/31/2023
Responses	34,623	0	34,623
Time Burden (Hours)	198,347	0	198,347
Cost Burden (Dollars)	0	0	0

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Abstract: This submission is being made for proposed non-substantive changes to an existing information collection pursuant to 44 U.S.C. § 3507. This submission seeks to make non-substantive changes to certain fields for the FCC Form 463 (the Invoice and Request for Disbursement Form for the Healthcare Connect Fund) and the Telecom Program Invoice Form to add a certification of compliance for service providers participating in the Rural Health Care program and the Connected Care Pilot program regarding rules adopted by the Commission in the Protecting Against National Security Threats to the Communications Supply Chain Through FCC Programs First Report and Order and the Second Report and Order, (WC Docket No. 18-89, FCC 19-121 (First Report and Order) and FCC 20-176 (Second Report and Order)). There are no proposed changes for the FCC Forms 460, 461, 462, 465, 466, or 467. The FCC Form 463 and the Telecom Program Invoice Form are contained in an online database. This submission is being made for a proposed non-substantive update to an existing information collection pursuant to 44 U.S.C. § 3507. The Commission resubmits the COVID-19 Telehealth Program Post-Program Report Template (Template) to be included as part of the existing information collection, which was approved by the Office of Management and Budget (OMB) on October 7, 2020 and on December 29, 2020, respectively. This request is correcting a typo on the first page of the Template to the OMB Control Number. There are no changes to the burdens and no cost are associated with this information collection. This submission is being made for a proposed non-substantive update to an existing information collection pursuant to 44 U.S.C. § 3507. The Commission submits the COVID-19 Telehealth Program Post-Program Report Template (Template) to be included as part of the existing information collection, which was approved by the Office of Management and Budget (OMB) on October 7, 2020. The FCC seeks approval to revise the existing collection 3060-1271 to also include information collection requirements for the Connected Care Pilot Program established by the Commission in the Report and Order entitled In the Matter of Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program (WC Docket No. 18-213, WC Docket No. 20-89, FCC 20-44). This collection is being revised to: (1) extend the existing information collection requirements for the COVID-19 Telehealth Program; (2) add new information collection requirements for the Connected Care Pilot Program; and (3) extend existing requirements applicable to both the COVID-19 Telehealth Program and the Connected Care Pilot Program. This information collection is necessary in order to facilitate the FCC’s and the Universal Administrative Company’s administration of the Programs, and to prevent waste, fraud, and abuse. The information will also allow the FCC to evaluate the extent to which the Programs are complying with the applicable rules and procedures for each program.

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Authorizing Statute(s): US Code: 47 USC 201-205 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 214, 254, 303(r), 403 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 1-4 Name of Law: Communications Act of 1934, as amended
   PL: Pub.L. 116 - 136 134 Stat. 281 Name of Law: Division B of the Coronavirus Aid, Relief, and Economic Security Act
   US Code: 47 USC 151-154 Name of Law: Communications Act of 1934, as amended
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3060-AK57	Final or interim final rulemaking	85 FR 19892	04/09/2020

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 36406	06/16/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 53001	08/27/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Business or other for-profit	N/A, N/A	COVID-19 Telehealth Program Application Form ,   COVID-19 Telehealth Request for Reimbursement Form
Federal Government	FCC Form 460	Description of Eligibility and Registration
State, Local or Tribal Governments	FCC Form 461, FCC Form 462, FCC Form 463, FCC Form 463	Request for Services ,   Request for Funding ,   Description of Request for Funding Disbursement ,   Description of Request for Funding Disbursement (FY2021+)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	34,623	34,623	0	0	0	0
Annual Time Burden (Hours)	198,347	198,347	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/04/2021

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