Information Collection

Businesses or other for-profit

IC 218853 under ICR 202403-3060-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form FCC Form 5630 Businesses or other for-profit	Form
Form FCC Form 5630 Businesses or other for-profit	Form
FCC Form 5630 Lifeline Annual Recertification Application Form FCC Form 5630 - Lifeline Progam Annual Recertification Form (2024 NSC).pdf	Form
FCC Form 5630 Lifeline Annual Recertification Application Form FCC Form 5630 - Lifeline Progam Annual Recertification Form (2024 NSC).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 FCC Form 5629 - Lifeline Program Application Form (2024 NSC).pdf	Form
FCC Form 5629 Lifeline Program Application Form FCC Form 5629 - Lifeline Program Application Form (2024 NSC).pdf	Form

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:

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 5630	Lifeline Annual Recertification Application Form	FCC Form 5630 - Lifeline Progam Annual Recertification Form (2024 NSC).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	FCC Form 5629 - Lifeline Program Application Form (2024 NSC).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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	13,438,702	13,438,702
Annual IC Time Burden (Hours)	3,267,187	3,267,187
Annual IC Cost Burden (Dollars)	468,750	468,750

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.