State, Local or Tribal Government

Application for Connect America Fund Phase II and Rural Digital Opportunity Fund Auction Support

Documents and Forms

Document Name Document Type
Form FCC Form 683 State, Local or Tribal Government Form
FCC Form 683 Rural Digital Opportunity Fund Long Form A904_Long_Form_06112020.docx Form
FCC Form 683 Rural Digital Opportunity Fund Long Form A904_Long_Form_06112020.docx Form

Information Collection (IC) Details

IC Title:	State, Local or Tribal Government	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 54.804 (c) 47 CFR 54.804 (b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 683	Rural Digital Opportunity Fund Long Form	A904_Long_Form_06112020.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: 265	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	465	-65	530
Annual IC Time Burden (Hours)	2,930	-780	3,710
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.