Information Collection

Business or other for-profit

IC 227297 under ICR 202303-3060-011 · OMB 3060-1241.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
New York Long-Form - Instructions (May 2018).docx	Instruction
FCC Form 5625 Connect America Phase II New York Long-Form Application New York Long-Form - FCC Form 5625 (February 2018).docx	Form

IC Title:

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 1.2002 47 CFR 54.315

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
Instruction			New York Long-Form - Instructions (May 2018).docx		Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5625	Connect America Phase II New York Long-Form Application	New York Long-Form - FCC Form 5625 (February 2018).docx		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: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

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.