Businesses or other for-profit

Bridging the Digital Divide for Low-Income Consumers, Lifeline and Link Up Reform and Modernization, Telecommunications Carriers Eligible for Universal Service Support

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 FCC Form 5630 - Lifeline Program Annual Recertification Form (March 2024).pdf Form
FCC Form 5630 Lifeline Annual Recertification Application Form FCC Form 5630 - Lifeline Program Annual Recertification Form (March 2024).pdf Form
FCC Form 5631 Lifeline Household Worksheet FCC Form 5631 - Lifeline Household Worksheet (June 2023).pdf Form
FCC Form 5631 Lifeline Household Worksheet FCC Form 5631 - Lifeline Household Worksheet (June 2023).pdf Form
FCC Form 5629 Lifeline Program Application Form FCC Form 5629 - Lifeline Program Application Form (clean).pdf Form
FCC Form 5629 Lifeline Program Application Form FCC Form 5629 - Lifeline Program Application Form (clean).pdf Form

Information Collection (IC) Details

IC Title:	Businesses or other for-profit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54.400, 54.403, 54.405 47 CFR 54.409, 54.410, 54.424 47 CFR 54.1800

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	FCC Form 5630 - Lifeline Program Annual Recertification Form (March 2024).pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5631	Lifeline Household Worksheet	FCC Form 5631 - Lifeline Household Worksheet (June 2023).pdf	Yes	Yes	Fillable Fileable Signable
Form	FCC Form 5629	Lifeline Program Application Form	FCC Form 5629 - Lifeline Program Application Form (clean).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: 86 FR 11526

Number of Respondents: 12,555,034	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,438,706	4	13,438,702
Annual IC Time Burden (Hours)	3,267,191	4	3,267,187
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.