Information Collection

Federal Government

IC 199666 under ICR 202407-3060-003 · OMB 3060-0804.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Post-Commitment Request Form (v.3 2.18.24) CLEAN.pdf	Other-Post Commitment Form
Post-Commitment Request Form (v.3 2.18.24) CLEAN.pdf	Other-Post Commitment Form
CMHC-Certification-Checklist (Nov 2023).pdf	Other-CMHC Certification Checklist
CMHC-Certification-Checklist (Nov 2023).pdf	Other-CMHC Certification Checklist
Telecommunications Program Invoice Form (Nov 2023).pdf	Other-RHC, Telecom Program, Invoice
Telecommunications Program Invoice Form (Nov 2023).pdf	Other-RHC, Telecom Program, Invoice

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 54.601(b) 47 CFR 54.601(c)

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Post Commitment Form	Post-Commitment Request Form (v.3 2.18.24) CLEAN.pdf	Yes	Yes	Fillable Fileable Signable
Other-CMHC Certification Checklist	CMHC-Certification-Checklist (Nov 2023).pdf	Yes	Yes	Fillable Fileable Signable
Other-RHC, Telecom Program, Invoice Form	Telecommunications Program Invoice Form (Nov 2023).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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	39,024	222	38,802
Annual IC Time Burden (Hours)	147,463	91	147,372
Annual IC Cost Burden (Dollars)	0	0	0

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.