Information Collection

Businesses or other for-profit

IC 218853 under ICR 202303-3060-015 · OMB 3060-0819.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0819 can be found here:

Documents and Forms

Document Name Document Type
Form FCC Form 5630 Businesses or other for-profit Form
FCC Form 5630 Lifeline Annual Recertification Application Form Lifeline Recertification_2023 Updates (FCC Form 5630).pdf Form
FCC Form 5630 Lifeline Annual Recertification Application Form Lifeline Recertification_2023 Updates (FCC Form 5630).pdf Form
FCC Form 5631 Lifeline Household Worksheet Lifeline Household Worksheet_2023 Updates (FCC Form 5631).pdf Form
FCC Form 5631 Lifeline Household Worksheet Lifeline Household Worksheet_2023 Updates (FCC Form 5631).pdf Form
FCC Form 5629 Lifeline Program Application Form Lifeline Application_2023 Updates (FCC Form 5629).pdf Form
FCC Form 5629 Lifeline Program Application Form Lifeline Application_2023 Updates (FCC Form 5629).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Businesses or other for-profit	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 54.101

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 5630	Lifeline Annual Recertification Application Form	Lifeline Recertification_2023 Updates (FCC Form 5630).pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5631	Lifeline Household Worksheet	Lifeline Household Worksheet_2023 Updates (FCC Form 5631).pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5629	Lifeline Program Application Form	Lifeline Application_2023 Updates (FCC Form 5629).pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title: FCC/WCB "Lifeline Program"	FR Citation: 82 FR 38686

Number of Respondents: 12,555,032	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,438,702	3,387,585	10,051,117
Annual IC Time Burden (Hours)	3,267,187	-998,740	4,265,927
Annual IC Cost Burden (Dollars)	468,750	0	468,750

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.