Business or other for-profit

COVID-19 Telehealth Program
Application

Filing Instructions

OMB Control No. 3060- 1271
2-19-2021

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Contents
COVID-19 Telehealth Program Overview .................................................................................................... 3
Resources for Applicants.............................................................................................................................. 4
I. Who Can Apply? ....................................................................................................................................... 5
II. What Must be Submitted? ...................................................................................................................... 6
A.

General Information:........................................................................................................................ 6

B.

Medical Services to be Provided with COVID-19 Telehealth Funding: ........................................... 7

C.

Conditions to be Treated with COVID-19 Telehealth Funding: ...................................................... 7

D.

Additional Information Concerning Requested Services and Devices ........................................... 7

E.

Requesting Funding Items................................................................................................................ 8

F.

Supporting Documentation ............................................................................................................. 8

IV. How to Apply.......................................................................................................................................... 9

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COVID-19 Telehealth Program Overview
On April 2, 2020, the Federal Communications Commission (FCC) adopted a Report and Order
establishing the COVID-19 Telehealth Program. The COVID-19 Telehealth Program will provide
$200 million in funding, appropriated by Congress as part of the Coronavirus Aid, Relief, and
Economic Security (CARES) Act, to help health care providers provide connected care services to
patients at their homes or mobile locations in response to the novel Coronavirus 2019 disease
(COVID-19) pandemic. The COVID-19 Telehealth Program will provide immediate support to
eligible health care providers responding to the COVID-19 pandemic by fully funding their
telecommunications services, information services, and devices necessary to provide critical
connected care services until the program’s funds have been expended or the COVID-19
pandemic has ended.
The application for the COVID-19 Telehealth Program, FCC Form 5636, is designed to obtain
information from applicants that will be used by the FCC to evaluate and select applications to
receive funding. The information is necessary to confirm eligibility, prioritize applications that
target areas hardest hit by the COVID-19 pandemic, and determine funding award amounts.
Applications will be reviewed as they are received, and funding awards will be made on a rolling
basis.
For more information regarding the COVID-19 Telehealth Program, please refer to the COVID19 Telehealth Program webpage at https://www.fcc.gov/covid19telehealth.
For more information regarding the FCC’s Coronavirus response, please see:
https://www.fcc.gov/coronavirus.

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Resources for Applicants
Eligibility Determination
For specific questions about eligibility and completing the eligibility form (FCC Form 460),
contact USAC via telephone at (800) 453-1546 or via email at: [email protected].
CORES (Commission Registration System)
If you need assistance with CORES, please contact the FRN Help Line at 877-480-3201 (M-F
8am-6pm ET) or submit a help request at https://www.fcc.gov/wireless/available-support services.
COVID-19 Telehealth Program
For specific questions about the application, please email
[email protected].
For all other questions, please email [email protected].

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I. Who Can Apply?
Health care providers seeking to participate in the COVID-19 Telehealth Program must obtain
an eligibility determination from the Universal Service Administrative Company (USAC) for each
health care provider site that they include in their application.
Health care provider sites that USAC has already deemed eligible to participate in the
Commission’s existing Rural Health Care (RHC) Programs may rely on that eligibility
determination for the COVID-19 Telehealth Program.
Health Care Provider Sites Without a Current USAC Eligibility Determination:
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Interested health care providers that do not already have an eligibility determination
may obtain one by filing an FCC Form 460 (Eligibility and Registration Form) with USAC.
FCC Form 460 can be filed through My Portal on USAC’s website at
https://www.usac.org/rural-health-care/resources/my-portal/. (Filers do not need to be
rural health care providers in order to file Form 460 for this purpose.)
Applicants that have not yet received an eligibility determination from USAC can still file
an application with the Commission for the COVID-19 Telehealth Program while their
FCC Form 460 is pending with USAC.
Consortium applicants may file an FCC Form 460 on behalf of member health care
providers if they have a Letter of Agency.
Contact USAC for specific questions about eligibility and completing the eligibility form
(FCC Form 460) via telephone at (800) 453-1546 or email at: [email protected].

All applicants to the COVID-19 Telehealth Program must also:
•

•

Obtain an FCC Registration Number (FRN) from the Commission Registration System
(CORES), as well as a CORES username and password at that link. An FRN is a 10-digit
number that is assigned to a business or individual registering with the FCC and is used
to identify the registrant’s business dealings with the FCC. For more details on this
process, see page 9 of this guide.
Register with the federal System for Award Management (SAM). For more details on
how to register, please see page 26 of this guide.
(While applicants do not need to be registered with the SAM in order to submit an
application, they will need to registered in order to receive funding, and the Bureau
strongly encourages applicants to start that process early.)

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II. What Must be Submitted?
In order to facilitate the application review process, applicants must complete each section of
the application, submit documentation to support the funding requested, and make the
required certifications at the end of the application. Specifically, health care providers must
submit an application with sufficient information that will allow the Bureau to make selections
and funding amount determinations. Please feel free to attach additional pages, as necessary,
to respond to the questions on the application. Failure to provide the requested information
may result in an application not being selected for funding under the COVID-19 Telehealth
Program.
Applicants may request that any materials or information submitted to the
Commission in its application be withheld from public inspection pursuant to the
procedures set forth in § 0.459 of the Commission’s rules.

A. General Information:
•

Applicant Information:
o Applicant Name
o Applicant FCC Registration Number (FRN)
o Applicant National Provider Identifier (NPI)
o Federal Employer Identification Number (EIN/Tax ID)
o Business Type (from Data Accountability and Transparency (DATA) Act Business
Types) – Applicants may provide up to three business types.
o DATA Act Service Area – This information will be required for each line item for
which funding is requested. Applicants must enter name of the applicable
state(s) or “nationwide.”

•

Contact Information:
o Contact name for the individual that will be responsible for the application
o Position title, Company Name
o Phone number
o Mailing address
o Email address

•

Health Care Provider (HCP) Information (for each HCP that is part of the application):
o Health care provider name (if there are multiple HCPs, the first is considered the
“lead” HCP)
o Facility name
o Indicate whether the facility is a hospital
o Street address, city, state, county
o FCC Registration Number (FRN)
o Healthcare provider number from FCC Form 460
o Eligibility type
o National Provider Identifier (NPI)
o Total patient population
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o Estimated number of patients to be served by the funding request (and
supporting documentation)

B. Medical Services to be Provided with COVID-19 Telehealth Funding:
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Patient-Based Internet-Connected Remote Monitoring
Other Monitoring
Video Consults
Voice Consults
Imaging Diagnostics
Other Diagnostics
Remote Treatment
Other services

C. Conditions to be Treated with COVID-19 Telehealth Funding:
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Whether the applicant will treat COVID-19 patients directly
Whether the applicant will treat patients without COVID-19 symptoms or conditions
If the applicant will treat patients without COVID-19, identify the types of conditions to
be treated or care to be provided (check all that apply):
o Other infectious diseases
o Emergency/Urgent Care
o Routine, Non-Urgent Care
o Mental Health Services (non-emergency)
o Other conditions
How using COVID-19 Telehealth Program funding to treat patients without COVID-19
symptoms or conditions would free up resources that will be used to treat COVID-19

D. Additional Information Concerning Requested Services and Devices
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Goals and objectives for use of the COVID-19 Telehealth Program Funding.
Timeline for deployment of the proposed service(s) or devices funded by the COVID-19
Telehealth Program.
Factors/metrics the applicant will use to help measure the impact of the services and
devices funded by the COVID-19 Telehealth Program.
How COVID-19 has affected health care providers in the applicant’s area.
Any additional information about the geographic area and population served by the
applicant. Indicate whether the geographic area served has been under any pre-existing
strain (e.g., large underserved or low-income patient population; HCP shortages; rural
hospital closures; limited broadband access and/or Internet adoption). If so, describe
such factors.
Whether the applicant plans to target the funding to high-risk and vulnerable patients.
If so, describe how.
Any additional information to support the application and request for funding.
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E. Requesting Funding Items
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Total amount of funding requested
Whether funding for devices is being requested. If so:
o How are the devices integral to patient care?
o Are the devices for patient use?
o Are the devices for the health care provider’s use?

F. Supporting Documentation
Applicants should provide supporting cost documentation (e.g., an invoice or a vendor
quote) for all eligible services and devices for which funding is requested. The detailed line
item information that is strongly encouraged for all eligible services and devices for which
funding is requested includes:
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•
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Category
Description of service(s) and/or device(s)
Quantities of services or devices
Total one-time expense
Total monthly expense
Expense date purchased or to be purchased
Service dates for recurring services

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III. When to Apply
Applications may be submitted through the FCC’s COVID-19 Telehealth online portal, accessible
at https://www.fcc.gov/covid19telehealth. Funding determinations will be made on a rolling basis
until program’s funds have been expended or the COVID-19 pandemic has ended.

IV. How to Apply
Applications may be submitted through the FCC’s COVID-19 Telehealth online portal, accessible
at https://www.fcc.gov/covid19telehealth. Applicants who have already started filling out the PDF
form may submit their applications to [email protected].
The Commission’s hand-delivery filing location is closed and cannot be used to submit
applications for the COVID-19 Telehealth Program. A copy of each completed application filed
will be automatically filed in ECFS at a later date. Confidential information should not be
included on the application form itself. Any confidential information for an application should
be submitted as an attachment. Applicants will have an opportunity to request confidential
treatment for confidential information included an attachment. This option is located on the
Purpose and Intent tab.

1. Obtain an FCC Registration Number (FRN)
All applicants, like all other entities doing business with the Commission, must register for
an FRN in the Commission Registration System (CORES). An FRN is a 10-digit number that is
assigned to a business or individual registering with the FCC. This unique FRN is used to
identify the registrant’s business dealings with the FCC.
To register with CORES, please use the following link:
https://apps.fcc.gov/cores/userLogin.do

The first step to setting up an account in CORES is creating a username and account in the
FCC User Registration System. Before the account is activated, the user will receive an
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automated email titled “FCC Account Request Verification” and must verify its account
email address as prompted.
Once the user is logged in to CORES, the user should select the “Register New FRN” or
“Associate Username to FRN” option as applicable from the menu options that appear and
provide the information as prompted by CORES.

Users will need to provide their taxpayer identification number or TIN to register. The TIN is
a nine-digit number that the Internal Revenue Service (IRS) requires of all individuals,
businesses, and other employers to identify their tax accounts with the IRS. Once the user
provides the information required in CORES and clicks “Submit,” CORES will generate a new
FRN or associate the user’s existing FRN with its account.

2. Sign In and Start a New Form:
Navigate to https://www.fcc.gov/covid19telehealth and select “Submit an Application Online.” You
will then be directed to a log in screen. Log into the system using your CORES username and
password:

If you have not created a CORES username and password, you must do so through the
FCC’s CORES webpage at https://apps.fcc.gov/cores/userLogin.do.
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After you log in, you will be directed to the COVID-19 Telehealth program landing page, shown below.
To initiate an application, click the “Start a New Application” button.

Tips for Navigating the Application:
1. Fully and accurately complete all fields on the form marked with an asterisk (*).
These fields are required and you must answer them for your application to be
complete. Required fields are also noted in the instructions.
2. To answer questions that require a more detailed response, consider drafting your
response in a separate document and then copying and pasting that response into
your application.
3. Save the form often to preserve your work; we recommend that you fully complete
each section and then save that section by clicking save at the bottom of the page
before moving to a new section.

4. Fully and accurately complete all fields on the form marked with an asterisk (*). These fields
are required and you must answer them for your application to be complete. Required fields
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are also noted in the instructions.
5. To answer questions that require a more detailed response, consider drafting your response

3. Enter Applicant Information
The unpopulated form shown below should appear:

Please Note: A consortium filing for multiple health care providers should use the information
of the lead entity for this section.
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Applicant FCC Registration Number (FRN) – Select your FCC Registration Number from
the drop-down menu in the box labeled FRN by typing the first few numbers. This field is
required.
Applicant National Provider Identifier (NPI) – Enter your 10-digit NPI obtained from the
National Plan and Provider Enumeration System. This field is optional.
Federal Employer Identification Number (EIN or TAX ID Number) – Enter your EIN or
Tax ID number. This field is required.
Data Universal Number System (DUNS) Number – Enter your unique business
identifier. This information is required by the 2014 Digital Accountability and
Transparency Act (DATA Act). This field is required.
Enter DATA Act Business Types
From the dropdown menu, choose three Business Types that best describe the
organization. These selections will be reported as part of the DATA Act and are required.

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Below is a list of the different Business Types and their description:
Code
A
B
C
D
E
F
G
H
I

J

K
L
M

N

O
P
Q
R
S
T
U
V
W
X

Code Label
State Government
County Government
City or Township government
Special District Government
Regional Organization
U.S. Territory or Possession
Independent School District
Public/State Controlled
Institution of Higher Education
Indian/Native American Tribal
Government (Federally Recognized)
Indian/Native American Tribal
Government (Other than
Federally-Recognized)
Indian/Native American Tribal
Designated Organization
Public/Indian Housing
Authority
Nonprofit with 501C3 IRS
Status (Other than an
Institution
of Higher Education)
Nonprofit without 501C3 IRS
Status (Other than an
Institution
of Higher Education)
Private Institution of Higher
Education
Individual
For-Profit Organization (Other
than Small Business)
Small Business
Hispanic-serving Institution
Historically Black College or
University (HBCU).
Tribally Controlled College or
University (TCCU)
Alaska Native and Native
Hawaiian Serving Institutions
Non-domestic (non-U.S.) Entity
Other

Code Description
The recipient is a U.S. state government.
The recipient is a U.S. county government.
The recipient is a U.S. city or township government
The recipient is a special district government.
The recipient is a U.S. regional organization.
The recipient is a U.S. territory or possession.
The recipient is a U.S. independent school district.
The recipient is a U.S. Public/State Controlled Institution of
Higher Education
The recipient is an Indian/Native American Tribal
Government (Federally Recognized)
The recipient is an Indian/Native American Tribal
Government (Other than Federally Recognized)
The recipient is an Indian/Native American Tribal
Designated Organization
The recipient is a Public/Indian Housing Authority
The recipient is a Nonprofit with 501C3 IRS Status (Other
than an Institution of Higher Education)

The recipient is a Nonprofit without 501C3 IRS Status (Other
than an Institution of Higher Education)

The recipient is a Private Institution of Higher Education
The recipient is an Individual
The recipient is a For-Profit Organization (Other than Small
Business)
The recipient is a Small Business
The recipient is an Hispanic-serving Institution
The recipient is a Historically Black College and University
(HBCUs)
The recipient is a Tribally Controlled College or University
(TCCUs)
The recipient is an Alaska Native and Native Hawaiian
Serving Institutions
The recipient is a Non-domestic (non-U.S.) Entity
The recipient is not covered under any of the other
categories above

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•

Service Area – Enter the state where applicant provides service or select “nationwide.”

Data Act Disclosure - The Name, Address, DUNS Number and Business Type will be disclosed in
accordance with Federal Funding Accountability and Transparency Act of 2006 (FFATA)/DATA
Act reporting requirements.

4. Enter Contact Information
You will then see a tab asking for additional information regarding your contact information,
shown below:

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Contact Name – Enter the name of the contact person for the application.
Position Title, Company Name – Enter the position title of the contact person for the
application and their company name.
Email – Enter the email address of the contact person for the application.
Phone – Enter the phone number of the contact person for the application.
Mailing Address – Enter the street, city, state, and zip code of the contact person for the
application.

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After entering Application Contact Information, please click the ‘Save Draft’
button. Then you will be able to enter information for the health care
providers associated with this application.

After clicking “Save Draft” button, the Health Care Provider tab will appear, as shown below. Click
“New” to enter the Health Care Provider Information.

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5. Enter Health Care Provider (HCP) Information
Upon clicking “New,” you will then be directed to an unpopulated form shown below:

Please Note: A consortium filing for multiple health care provider sites must fill out a new
health care provider tab for each site it is filing on behalf of.
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Facility Name – Enter the health care provider facility name or name of lead entity for a
consortium. This field is required.
FRN – Enter the FCC Registration Number for each health care provider (or entity). This
field is required.
Is Lead HCP – Select “yes” if this provider (or entity) is the lead for the application.
Select “no” for all additional health care provider site. This field is required.
HCP Number – Enter the HCP Number assigned from FCC Form 460. This field is
optional.
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Eligibility Type – Enter the eligibility type selected on your FCC Form 460. This field is
optional. Health Care Provider Eligibility Types eligible for funding under the COVID-19
Telehealth Program include:
(1) post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools
(2) community health centers or health centers providing health care to migrants
(3) local health departments or agencies
(4) community mental health centers
(5) not-for-profit hospitals
(6) for-profit dedicated emergency rooms
(7) health clinics
(8) skilled nursing facilities
(9) consortia of health care providers consisting of one or more entities falling in categories (1)-(8)

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Address – Entering the street address, city, and state where the health care provider (or
entity) is located. This field is required.
NPI – Enter the 10-digit NPI obtained from the National Plan and Provider Enumeration
System for the health care provider. This field is optional.
County – Enter the county where the health care provider is located. This field is
required.
Is the Facility a Hospital? – Select “yes” if this provider is a hospital; otherwise select
“no.” This field is required.
Total Patient Population – Enter the number of patients each health care provider site
treats each year. This field is required. Applicants are encouraged to provide additional
explanation or supporting documentation as an attachment.
Estimated Number of Patients to be Served – Enter the total estimate of patients that
will be served with the funds requested. This field is required. Applicants are
encouraged to provide additional explanation or supporting documentation.
Application Tip: Be sure to click “Save” after completing the HCP tab.

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6. Enter Services and Conditions
You will then see a tab asking for additional information on services and conditions, shown
below:

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Medical Services to be Provided with COVID-19 Telehealth Funding – Check all medical
services that the health care provider sites in the application plan to provide with
requested funding. You are encouraged to provide additional explanation in the text
box.
Conditions to be Treated with COVID-19 Telehealth Funding – Identify whether you
plan to treat patients with COVID-19 or other patients to free up resources. If you
answer “yes” to treating patients without COVID-19 symptoms, you must select which
conditions you will treat and explain how using this funding will free up resources to
treat COVID-19. You are encouraged to provide additional explanation in the text box.

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7. Purpose and Intent
You will then see a tab asking for additional information on your purpose and intent for the
requested funding, shown below:

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What are your goals and objectives for use of the COVID-19 Telehealth Program
Funding – Please explain what you aim to accomplish with the funding requested. This
question is required.
What is your timeline for deployment of the proposed service(s) or devices funded by
the COVID-19 Telehealth Program? – Please explain the timing of purchase and
deployment for the service(s) and devices you are requesting funding for. This question
is required.
What factors/metrics will you use to help measure the impact of the services and
devices funded by the COVID-19 Telehealth Program? – Please explain what factors
and/or metrics you intend to use to measure the impact of the services and devices
funded by the program. This question is required.
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•

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Please provide additional information about the geographic area and population you
serve. – Please explain if your area has any pre-existing strain factors, such as a large
underserved or low-income patient population, recent health care provider closures or
other deficiencies. This question is optional.
Do you plan to target the funding to high-risk and vulnerable patients? -- Please
choose from the drop down either “yes” or “no.” This question is required.
Additional Information for Targeting High Risk Patients -- If applicable, please
elaborate on how you plan to target high risk patients with additional funding. This
question is optional.

8. Confidentiality
By designating supporting documents and information as “Confidential,” the applicant is
deemed to have submitted a request that the material be withheld from public inspection
pursuant to 47 CFR § 0.459. Applicants designating documents as “Confidential” should not
submit those documents in the FCC’s Electronic Comment Filing System.
To request confidential treatment of supporting documentation, answer “Yes” to the question
on the bottom of the Purposes and Intent tab. Confidential information should not be included
on the application form itself. Any confidential information should be submitted as an
attachment.

9. Funding Requested
You will then see a tab asking for additional information on your funding request, shown
below:

•

Please note: Applicants can only seek funding for (a) Internet/broadband or voice
connectivity services and (b) devices that are connected to the internet or a
broadband/voice network and used for patient care, monitoring, treatment, or
diagnostics
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Examples of services and devices that COVID-19 Telehealth Program applicants may
seek funding for include:
o Telecommunications Services and: Voice service .
o Information Services: Internet connectivity services for health care providers or
their patients; remote patient monitoring platforms and services; patient
reported outcome platforms; store and forward services, such as asynchronous
transfer of patient images and data for interpretation by a physician; platforms
and services to provide synchronous video consultation.
o Internet Connected Devices/Equipment: tablets, smart phones, or connected
devices to receive connected care services at home (e.g., broadband enabled
blood pressure monitors; pulse-ox; etc.) for patient or health care provider use;
telemedicine kiosks/carts for health care provider site.

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Total amount of funding requested – Please enter the total amount of funding in a
dollar amount; please note that we do not anticipate awarding more than $1 million in
funding to any one applicant. This question is required.
Are you requesting funding for devices – Please choose from the drop down either
“yes” or “no.” This question is required.
How are devices integral to patient care – Please explain how these devices are
necessary to provide care to your patient population. This question is required if you are
requesting funding for devices.
Are the devices for patient use -- Please choose from the drop down either “yes” or
“no.” This question is required if you are requesting funding for devices.
Are the devices for the health care provider’s use -- Please choose from the drop down
either “yes” or “no.” This question is required if you are requesting funding for devices.

•
•
•
•

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10. Supporting Documentation
An applicant should provide supporting documentation for the costs indicated in its application.
Such supporting documentation should summarize the expected costs of the eligible services
and devices requested and may include documentation such as an invoice or quote from a
vendor or service provider (or similar information). Such information should be specific enough
to identify line-items to facilitate swift review of the application, and we encourage applicants
to include information such as a description of the service or device, its eligibility category, the
quantity ordered, the upfront and monthly expenses, and the service dates for recurring
services.
Note: Supporting Cost Documentation is required material.
Supporting documentation can be attached at the top of the application, as shown below:

Applicants may also provide additional detail for the funding request in the funding request
details table at the bottom of the page. Switch to the Funding Request Details tab, as shown
below. Click “New” to enter these details.

Upon clicking “New,” you will then be directed to an unpopulated form shown below:

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•
•
•
•
•
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Category – Please select the category that best fits the line item. This field is optional.
Description of Service(s) and/or Device(s) – Please briefly describe the line item service
or device(s) on the funding request. This field is optional.
Quantities (for devices) – Please enter the line item quantity for devices.
Total One-Time Expense – Please enter the total one-time expense associated with the
line item. This field is optional.
Total Monthly Expense – Please enter the total monthly expense associated with the
line item. This field is optional.
Date – Please enter the date the line service or device(s) were purchased or the date to
be purchased. This field is optional.
Number of Months for Recurring Service – Please enter the total number of months for
the line item. This field is optional.

Applicants can optionally create a new item in the funding request details table for each line
item.
Application Tip: Be sure to click “Save” after completing the Funding Request Details tab.
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11. Certify & Submit
When you are ready to submit the information, please click the “Submit” button on the
certifications tab. Carefully read the language that appears in the Certify Submission popup window and click then click “Certify & Submit” button. See Certification below for more
information.

You will then see a confirmation of submission in green, shown below:

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12. Revise an Application In Progress
Once you have saved a draft of a filing or submitted a filing, the filing will be listed under
Telehealth Applications on the Covid-19 Telehealth Program landing page, below the “Start
a New Form” button.
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In Progress Status
Applications that have been saved but not submitted will be have a Status of “In
Progress.” If you click on the application listed in the table, you can return to the
submission form to add to or change the information entered, and then click Save or
Certify & Submit.

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Submitted Status
Applications that have been certified and submitted (see Step 11 above) will have a
Status of “Submitted” in the Telehealth Applications table. If you click on the link to a
Submitted filing, you will be able to view the information you submitted for that filing.

•

Needs More Information Status
If your application needs additional information, application reviewers will contact you.
You will then have the opportunity to revise your application and provide additional
supporting documentation.

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13. Final Steps:
Registering with System for Award Management:
To receive payments through the COVID-19 Telehealth Program, applicants must be
registered with the federal System for Award Management. The System for Award
Management is a web-based, government-wide application that collects, validates, stores,
and disseminates business information about the federal government’s partners in support
of federal awards, grants, and electronic payment processes. Many applicants may already
be registered with the System for Award Management and do not need to re-register with
that system in order to receive payment through the COVID-19 Telehealth Program.
Health care providers not yet registered with the System for Award Management may still
submit an application. However, it is strongly recommended that unregistered health care
providers start that registration process now because it may take up to 10 business days for
your registration to become active and an additional 24 hours before that registration
information is available in other government systems.
To register with the system:
Go to https://www.sam.gov/SAM/ with the following information:
• (1) DUNS number;
• (2) Taxpayer Identification Number (TIN) or Employment Identification Number
(EIN); and
• (3) Your bank’s routing number, your bank account number, and your bank account
type, i.e. checking or savings, to set up Electronic Funds Transfer (EFT).
You will receive a confirmation email once the registration is activated. Only applicants
registered through the System for Award Management will be able to receive COVID-19
Telehealth Program funding.

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CARES Act Reporting Requirements
As part of this information collection and not later than 10 days after the end of each calendar
quarter, each entity recipient that receives COVID-19 Telehealth Program funds that amount to
more than $150,000 must submit to the FCC and the Pandemic Response Accountability
Committee a report that contains—(A) the total amount of large covered funds received from
the agency; (B) the amount of large covered funds received that were expended or obligated
for each project or activity; (C) a detailed list of all projects or activities for which large covered
funds were expended or obligated, including—(i) the name of the project or activity; (ii) a
description of the project or activity; and (iii) the estimated number of jobs created or retained
by the project or activity, where applicable; and (D) detailed information on any level of
subcontracts or subgrants awarded by the covered recipient or its subcontractors or
subgrantees, to include the data elements required to comply with the Federal Funding
Accountability and Transparency Act of 2006 (FFATA) (31 U.S.C. 6101 note) allowing aggregate
reporting on awards below $50,000 or to individuals, as prescribed by the Director of the Office
of Management and Budget. Not later than 30 days after the end of each calendar quarter, the
Committee, in consultation with the FCC will make this information publicly available by posting
the information on the website established under section 15010(g).

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FCC NOTICE FOR INDIVIDUALS REQUIRED BY THE PRIVACY ACT AND THE PAPERWORK
REDUCTION ACT
Part 3 of the Commission’s Rules authorize the Commission to request the information on this form. The purpose
of the information is to obtain information from applicants that will be used by the Commission to evaluate the
applications and select applications to receiving funding under the COVID-19 Telehealth Program. In selecting
participants for the COVID-19 Telehealth Program, this information is necessary to select applications that target
areas hardest hit by COVID-19 where the support will have the most impact on addressing immediate health care
needs, determine funding awards and subsequently issue disbursements. Failure to provide the requested
information, may result in an application not being selected for funding under the COVID-19 Telehealth Program.
Information requested by this form may be made available for public inspection after the Commission staff
completes its review. If a request for public inspection under the Commission’s rules is made for an applicant’s
information, the applicant will be notified and then must justify the continued confidential treatment of the
information if it objects to the disclosure.
We have estimated that your response to this collection of information will take an average of 15 hours. Our
estimate includes the time to read the instructions, look through existing records, gather and maintain required
data, and actually complete and review the form or response. If you have any comments on this estimate, or on how
we can improve the collection and reduce the burden it causes you, please write the Federal Communications
Commission, Office of Managing Director, AMD PERM, Washington, DC 20554, Paperwork Reduction Act
Project (3060-1271). We will also accept your PRA comments via the Internet if you send an e-mail to
[email protected].
Please DO NOT SEND COMPLETED APPLICATION FORMS TO THIS ADDRESS. You are not required to
respond to a collection of information sponsored by the Federal government, and the government may not conduct
or sponsor this collection, unless it displays a currently valid OMB control number and/or we fail to provide you
with this notice. This collection has been assigned an OMB control number of 3060-1271.
THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31, 1974, 5
U.S.C. 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1,
1995, 44 U.S.C. SECTION 3507.