State, Local, or Tribal Government

Universal Service - Schools and Libraries Universal Service Program, FCC Forms 470 and 471

Documents and Forms

Document Name Document Type
Form FCC 471 State, Local, or Tribal Government Form
FCC 471 Description of Services Requested and Certification Form 3060-0806 Extension (Form 471 Field Descriptions).6.14.24.docx Form
FCC 471 Description of Services Requested and Certification Form 3060-0806 Extension (Form 471 Field Descriptions).6.14.24.docx Form

Information Collection (IC) Details

IC Title:	State, Local, or Tribal 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 54.500 47 CFR 54.516(a)-(d) 47 CFR 54.501(a) - (c) 47 CFR 54.502(a) - (d) 47 CFR 54.504(a) - (f)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC 471	Description of Services Requested and Certification Form - Field Descriptions	3060-0806 Extension (Form 471 Field Descriptions).6.14.24.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,500	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	41,780	25,005	16,775
Annual IC Time Burden (Hours)	118,445	49,957	68,488
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.