Information Collection

Business or other for-profit

IC 31049 under ICR 202407-3060-003 · OMB 3060-0804.

Documents and Forms

Document Name Document Type
Form FCC Form 460 Business or other for-profit Form and Instruction
FCC Form 460 RHC, Healthcare Connect Fund Program and Telecommunicati FCC Form 460 - Eligibility and Registration (v.3 - 6.27.24) CLEAN.pdf Form and Instruction
FCC Form 460 RHC, Healthcare Connect Fund Program and Telecommunicati FCC Form 460 - Eligibility and Registration (v.3 - 6.27.24) CLEAN.pdf Form and Instruction
FCC Form 461 RHC, Healthcare Connect Fund Program, Description of Req FCC Form 461 - Request for Service (2.22.24) CLEAN.pdf Form and Instruction
FCC Form 461 RHC, Healthcare Connect Fund Program, Description of Req FCC Form 461 - Request for Service (2.22.24) CLEAN.pdf Form and Instruction
FCC Form 462 RHC, HCFP, Description of Request for Funding FCC Form 462 - Request for Funding (Nov 2023).pdf Form and Instruction
FCC Form 462 RHC, HCFP, Description of Request for Funding FCC Form 462 - Request for Funding (Nov 2023).pdf Form and Instruction
FCC Form 463 RHC, HCFP, Description of Request for Funding Disburseme FCC Form 463 - Request for Funding Disbursement (Nov 2023).pdf Form and Instruction
FCC Form 463 RHC, HCFP, Description of Request for Funding Disburseme FCC Form 463 - Request for Funding Disbursement (Nov 2023).pdf Form and Instruction
FCC Form 465 RHC, Telecommunications Program, Description of Eligibil FCC Form 465 - Eligibility and Request for Services (v.2 - 2.16.24) CLEAN.pdf Form and Instruction
FCC Form 465 RHC, Telecommunications Program, Description of Eligibil FCC Form 465 - Eligibility and Request for Services (v.2 - 2.16.24) CLEAN.pdf Form and Instruction
FCC Form 466 RHC, Telecommunications Program, Description of Request FCC Form 466 - Request for Funding (Nov 2023).pdf Form and Instruction
FCC Form 466 RHC, Telecommunications Program, Description of Request FCC Form 466 - Request for Funding (Nov 2023).pdf Form and Instruction
FCC Form 467 RHC, Telecommunications Program, Connection Certificatio FCC Form 467 - Connection Certification Form (Nov 2023).pdf Form and Instruction
FCC Form 467 RHC, Telecommunications Program, Connection Certificatio FCC Form 467 - Connection Certification Form (Nov 2023).pdf Form and Instruction
FCC Form 469 RHC, Telecommunications Program, Description of Invoice FCC Form 469 - Invoice and Request for Disbursement (Nov 2023).pdf Form and Instruction
FCC Form 469 RHC, Telecommunications Program, Description of Invoice FCC Form 469 - Invoice and Request for Disbursement (Nov 2023).pdf Form and Instruction

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 54.627 47 CFR 54.605

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FCC Form 460	RHC, Healthcare Connect Fund Program and Telecommunications Program	FCC Form 460 - Eligibility and Registration (v.3 - 6.27.24) CLEAN.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC Form 461	RHC, Healthcare Connect Fund Program, Description of Request for Services	FCC Form 461 - Request for Service (2.22.24) CLEAN.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC Form 462	RHC, HCFP, Description of Request for Funding	FCC Form 462 - Request for Funding (Nov 2023).pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC Form 463	RHC, HCFP, Description of Request for Funding Disbursement	FCC Form 463 - Request for Funding Disbursement (Nov 2023).pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC Form 465	RHC, Telecommunications Program, Description of Eligibility and Request for Services	FCC Form 465 - Eligibility and Request for Services (v.2 - 2.16.24) CLEAN.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC Form 466	RHC, Telecommunications Program, Description of Request for Funding	FCC Form 466 - Request for Funding (Nov 2023).pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC Form 467	RHC, Telecommunications Program, Connection Certification Form	FCC Form 467 - Connection Certification Form (Nov 2023).pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FCC Form 469	RHC, Telecommunications Program, Description of Invoice and Request for Disbursement	FCC Form 469 - Invoice and Request for Disbursement (Nov 2023).pdf	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

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: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	39,023	222	38,801
Annual IC Time Burden (Hours)	147,463	91	147,372
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.