FCC Forms 479, 486 and 500 (state, local or tribal entities)

Certification by Administrative Authority to Billed Entity Compliance with the Children's Internet Protection Act Form; Certification of Compliance with the CIPA and Technology Plan Requirements Form;

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0853 can be found here:

Documents and Forms

Document Name Document Type
FCC Form 500 Screen Shots - 7.12.2019.docx Other-FCC Form 500 Screen Shot
FCC Form 500 Screen Shots - 7.12.2019.docx Other-FCC Form 500 Screen Shot
FCC Form 500 PRA Screen Shots 4_22_2021.docx Other-FCC Form 500 Screenshot
FCC Form 500 PRA Screen Shots 4_22_2021.docx Other-FCC Form 500 Screenshot

Information Collection (IC) Details

IC Title:	FCC Forms 479, 486 and 500 (state, local or tribal entities)	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 54.507(d) 47 CFR 54.508(c) 47 CFR 54.513(d) 47 CFR 54.520 47 CFR 54.516

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-FCC Form 500 Screen Shot			FCC Form 500 Screen Shots - 7.12.2019.docx		Yes	Yes	Fillable Fileable Signable
Other-FCC Form 500 Screenshot			FCC Form 500 PRA Screen Shots 4_22_2021.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29,250	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 65 %

	Approved	Previously Approved
Annual Number of Responses for this IC	29,250	29,250
Annual IC Time Burden (Hours)	26,688	26,688
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.