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Federal Government
Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program
OMB: 3060-1271
IC ID: 241112
OMB.report
FCC
OMB 3060-1271
ICR 202504-3060-005
IC 241112
( )
Documents and Forms
Document Name
Document Type
Form FCC Form 460
Federal Government
Form
Community Mental Health Center (CMHC) Checklist (Nov 2023).pdf
Other-CMHC Checklist
Connected Care Pilot Program Instructions.pdf
Instruction
Connected Care Pilot Program Questionnaire.pdf
Other-Connected Care Pilot Program Q
COVID-19 Telehealth Program Post Program Report Template.docx
Other-COVID-19 Telehealth Program Po
FCC Form 460 Description of Eligibility and Registration
FCC Form 460 - Description of Eligibility and Registration (Sept 2024).pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Federal Government
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
FCC Form 460
Description of Eligibility and Registration
FCC Form 460 - Description of Eligibility and Registration (Sept 2024).pdf
Yes
Yes
Fillable Fileable Signable
Other-CMHC Checklist
Community Mental Health Center (CMHC) Checklist (Nov 2023).pdf
Yes
Yes
Fillable Printable
Instruction
Connected Care Pilot Program Instructions.pdf
Yes
Yes
Fillable Printable
Other-Connected Care Pilot Program Questionnaire
Connected Care Pilot Program Questionnaire.pdf
Yes
Yes
Fillable Fileable Signable
Other-COVID-19 Telehealth Program Post-Program Report Template
COVID-19 Telehealth Program Post Program Report Template.docx
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:
2,403
Number of Respondents for Small Entity:
0
Affected Public:
Federal Government
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
11,518
0
0
0
0
11,518
Annual IC Time Burden (Hours)
65,929
0
0
0
0
65,929
Annual IC Cost Burden (Dollars)
0
0
0
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.