Information Collection

Legacy High-Cost Support Usage Flexibility Certification

IC 247087 under ICR 202104-3060-014 · OMB 3060-1289.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Certification Form Legacy High-Cost Support Usage Flexibility Certification	Form
Certification Form Legacy High-Cost Support Usage Flexibility Certification Legacy Support Usage Flexibility Certification_rev 2-8-21 (FINAL).pdf	Form
Certification Form Legacy High-Cost Support Usage Flexibility Certification Legacy Support Usage Flexibility Certification_rev 2-8-21 (FINAL).pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54.322(c)(4)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Certification Form	Legacy High-Cost Support Usage Flexibility Certification	Legacy Support Usage Flexibility Certification_rev 2-8-21 (FINAL).pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	8,250	8,250

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.