Information Collection

Businesses or other for-profit

IC 218853 under ICR 202504-3060-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form FCC Form 5630 Businesses or other for-profit Form
Form FCC Form 5630 Lifeline Annual Recertification Application Form Businesses or other for-profit Form
Form FCC Form 5631 Lifeline Household Worksheet Businesses or other for-profit Form
Form FCC Form 5629 Lifeline Program Application Form Businesses or other for-profit Form
IC 3060-0819 SCA Survey Form 9.19.24.pdf Other-Lifeline Program Survey Form
IC 3060-0819 SCA Survey Form 9.19.24.pdf Other-Lifeline Program Survey Form
FCC Form 5630 Lifeline Annual Recertification Application Form FCC Form 5630 - Lifeline Program Annual Recertification Form (Rev.01.22.25).pdf Form
FCC Form 5630 Lifeline Annual Recertification Application Form FCC Form 5630 - Lifeline Program Annual Recertification Form (Rev.01.22.25).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 (Ver._Rev.01.17.25).pdf Form
FCC Form 5629 Lifeline Program Application Form FCC Form 5629 - Lifeline Program Application Form (Ver._Rev.01.17.25).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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

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 (Rev.01.22.25).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 (Ver._Rev.01.17.25).pdf	Yes	Yes	Fillable Fileable Signable
Other-Lifeline Program Survey Form			IC 3060-0819 SCA Survey Form 9.19.24.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: 12,555,684	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: 80 %

	Approved	Previously Approved
Annual Number of Responses for this IC	13,439,356	13,439,356
Annual IC Time Burden (Hours)	3,267,300	3,267,300
Annual IC Cost Burden (Dollars)	468,750	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].