Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FCC Form 460 Description of Eligibility and Registration	Form	Modified	Available
Form FCC Form 460 Federal Government	Form	Modified	Repair queued
Form FCC Form 463 Description of Request for Funding Disbursement	Form	Modified	Available
Form FCC Form 462 Request for Funding	Form	Modified	Available
Form FCC Form 461 Request for Services	Form	Modified	Available
Post-Commitment Request Form	Form	Modified	Available
COVID-19 Telehealth Request for Reimbursement Form	Form	Modified	Available
COVID-19 Telehealth Program Application Form	Form	Modified	Available
Business or other for-profit	Form	Modified	Repair queued
3060-1271 - SS _May final version.docx	Supporting Statement A	Uploaded 2025-05-28	Available
3060-1271 - SS _May final version.docx	Supporting Statement A	Uploaded 2025-05-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241112	Federal Government	Form	Modified	Description of Eligibility and Registration
241112	Federal Government	Form	Modified
241112	Federal Government	Other-CMHC Checklist	Modified
241111	State, Local or Tribal Governments	Form	Modified	Description of Request for Funding Disbursement
241111	State, Local or Tribal Governments	Form	Modified	Request for Funding
241111	State, Local or Tribal Governments	Form	Modified	Request for Services
241111	State, Local or Tribal Governments	Other-COVID-19, Telehealth Program, LOA	Modified
241110	Business or other for-profit	Form	Modified	Post-Commitment Request Form
241110	Business or other for-profit	Form	Modified	COVID-19 Telehealth Request for Reimbursement Form
241110	Business or other for-profit	Form	Modified	COVID-19 Telehealth Program Application Form
241110	Business or other for-profit	Form	Modified
241110	Business or other for-profit	Instruction	Modified

ICR Details

OMB Control No: 3060-1271	ICR Reference No: 202504-3060-005
Status: Active	Previous ICR Reference No: 202206-3060-014
Agency/Subagency: FCC	Agency Tracking No: WCB
Title: Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/05/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/29/2025
Terms of Clearance: Actually just an extension, not a revision.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2028	36 Months From Approved	08/31/2025
Responses	34,553	0	34,553
Time Burden (Hours)	197,787	0	197,787
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection extends the existing requirements for both the Connected Care Pilot Program and the COVID-19 Telehealth Program.

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Authorizing Statute(s): US Code: 47 USC 214, 254, 303(r), 403 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 1-4 Name of Law: Communications Act of 1934, as amended
   US Code: 47 USC 201-205 Name of Law: Communications Act of 1934, as amended
   PL: Pub.L. 116 - 136 134 Stat. 281 Name of Law: Division B of the Coronavirus Aid, Relief, and Economic Security Act
   US Code: 47 USC 151-154 Name of Law: Communications Act of 1934, as amended
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 11319	03/05/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 22479	05/28/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Business or other for-profit	N/A, N/A, N/A	COVID-19 Telehealth Program Application Form ,   COVID-19 Telehealth Request for Reimbursement Form ,   Post-Commitment Request Form
Federal Government	FCC Form 460	Description of Eligibility and Registration
State, Local or Tribal Governments	FCC Form 461, FCC Form 462, FCC Form 463	Request for Services ,   Request for Funding ,   Description of Request for Funding Disbursement

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	34,553	34,553	0	0	0	0
Annual Time Burden (Hours)	197,787	197,787	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/29/2025

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