Information Collection

Business or other for profit

IC 239106 under ICR 202312-3060-005 · OMB 3060-1270.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-1270 can be found here:

2026-04-09 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FCC Form 5641 Business or other for profit	Form
Part G User Guide_Broadband Providers_UPDATED_10-06-2023.docx	Other-FCC Form 5640 User Guide (Part
Part G User Guide_Broadband Providers_UPDATED_10-06-2023.docx	Other-FCC Form 5640 User Guide (Part
FCC Form 5641 Annual Report, Section 1.50007 3060-1270_Info_Template 1.50007 (111021).docx	Form
FCC Form 5641 Annual Report, Section 1.50007 3060-1270_Info_Template 1.50007 (111021).docx	Form
FCC Form 5640 Individual Term Extension Request, Section 1.50004(h)(2) 3060-1270_Info_Template 1.50004(h)(2) (111021).docx	Form
FCC Form 5640 Individual Term Extension Request, Section 1.50004(h)(2) 3060-1270_Info_Template 1.50004(h)(2) (111021).docx	Form
FCC Form 5640 Status Updates, Section 1.50004(k) status update form (form 5640 1.50004k) 2.13.23_clean version .docx	Form
FCC Form 5640 Status Updates, Section 1.50004(k) status update form (form 5640 1.50004k) 2.13.23_clean version .docx	Form
FCC Form 5640 Spending Reports, Section 1.50004(l) spending report form (1.50004(I)).clean version .docx	Form
FCC Form 5640 Spending Reports, Section 1.50004(l) spending report form (1.50004(I)).clean version .docx	Form
FCC Form 5640 Final Certification and Updates, Section 1.50004(m) 3060-1270_Info_Template 1.50004(m) (111021).docx	Form
FCC Form 5640 Final Certification and Updates, Section 1.50004(m) 3060-1270_Info_Template 1.50004(m) (111021).docx	Form
FCC Form 5640 Application Request for Funding Allocation, Section 1.50 3060-1270_Info_Template 1.50004(c) (111021) (3).docx	Form
FCC Form 5640 Application Request for Funding Allocation, Section 1.50 3060-1270_Info_Template 1.50004(c) (111021) (3).docx	Form
FCC Form 5640 Reimbursement Claim Request, Section 1.50004(g) 3060-1270_Info_Template 1.50004(g) (111021).docx	Form
FCC Form 5640 Reimbursement Claim Request, Section 1.50004(g) 3060-1270_Info_Template 1.50004(g) (111021).docx	Form
FCC 5640 Ownership Change Notification 3060-1270_Info_Template Ownership Change NT 111721_new.docx	Form
FCC 5640 Ownership Change Notification 3060-1270_Info_Template Ownership Change NT 111721_new.docx	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Business 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 1.50004(d)(1) 47 CFR 1.50004(h)(2) 47 CFR 1.50004(g) 47 CFR 1.50007 47 CFR 1.50004(c) 47 CFR 1.50004(k) 47 CFR 1.50004(l) 47 CFR 1.50004(j) 47 CFR 1.50004(m) 47 CFR 1.50004(n)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 5641	Annual Report, Section 1.50007	3060-1270_Info_Template 1.50007 (111021).docx	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5640	Individual Term Extension Request, Section 1.50004(h)(2)	3060-1270_Info_Template 1.50004(h)(2) (111021).docx	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5640	Status Updates, Section 1.50004(k)	status update form (form 5640 1.50004k) 2.13.23_clean version .docx	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5640	Spending Reports, Section 1.50004(l)	spending report form (1.50004(I)).clean version .docx	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5640	Final Certification and Updates, Section 1.50004(m)	3060-1270_Info_Template 1.50004(m) (111021).docx	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5640	Application Request for Funding Allocation, Section 1.50004(c)	3060-1270_Info_Template 1.50004(c) (111021) (3).docx	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5640	Reimbursement Claim Request, Section 1.50004(g)	3060-1270_Info_Template 1.50004(g) (111021).docx	Yes	Yes	Fillable Fileable Signable
Form	FCC 5640	Ownership Change Notification	3060-1270_Info_Template Ownership Change NT 111721_new.docx	Yes	Yes	Fillable Fileable Signable
Other-FCC Form 5640 User Guide (Part G & C)			Part G User Guide_Broadband Providers_UPDATED_10-06-2023.docx	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,584	6,584
Annual IC Time Burden (Hours)	20,236	20,236
Annual IC Cost Burden (Dollars)	472,500	472,500

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.