Universal Service - Rural Health Care Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0804 can be found here:

Documents and Forms

Document Name Document Type
2023 Post-Commitment Request Form.docx Other-Post Commitment Form
2023 Post-Commitment Request Form.docx Other-Post Commitment Form
2023 RHC CMHC-Certification-Checklist.docx Other-CMHC Certification Checklist
2023 RHC CMHC-Certification-Checklist.docx Other-CMHC Certification Checklist
2023 Telecom Program Invoice.docx Other-RHC, Telecom Program Invoice F
2023 Telecom Program Invoice.docx Other-RHC, Telecom Program Invoice F

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Universal Service - Rural Health Care Program	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 54.600 - 54.633

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Post Commitment Form	2023 Post-Commitment Request Form.docx	Yes	Yes	Fillable Fileable Signable
Other-CMHC Certification Checklist	2023 RHC CMHC-Certification-Checklist.docx	Yes	Yes	Fillable Fileable Signable
Other-RHC, Telecom Program Invoice Form	2023 Telecom Program Invoice.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: 4,281	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	34,227	2,998	31,229
Annual IC Time Burden (Hours)	137,820	10,240	127,580
Annual IC Cost Burden (Dollars)	0	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.