Federal Government

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⚠️ Notice: This information collection may be referencing outdated material.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 Revision Post-Commitment Request Form_v2.pdf Other-Post Commitment Form
2023 Revision Post-Commitment Request Form_v2.pdf Other-Post Commitment Form
2023 Revision RHC CMHC-Certification-Checklist.pdf Other-CMHC Certification Checklist
2023 Revision RHC CMHC-Certification-Checklist.pdf Other-CMHC Certification Checklist
2023 Revision Telecom Program Invoice.pdf Other-RHC, Telecom Program, Invoice
2023 Revision Telecom Program Invoice.pdf Other-RHC, Telecom Program, Invoice

Information Collection (IC) Details

IC Title:	Federal 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 54.605

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Post Commitment Form	2023 Revision Post-Commitment Request Form_v2.pdf	Yes	Yes	Fillable Fileable Signable
Other-CMHC Certification Checklist	2023 Revision RHC CMHC-Certification-Checklist.pdf	Yes	Yes	Fillable Fileable Signable
Other-RHC, Telecom Program, Invoice Form	2023 Revision Telecom Program Invoice.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,284	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	38,802	4,575	34,227
Annual IC Time Burden (Hours)	147,372	9,552	137,820
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.