Information Collection

Federal Government

IC 241112 under ICR 202504-3060-005 · OMB 3060-1271.

Documents and Forms

Document Name Document Type
Form FCC Form 460 Federal Government Form
Form FCC Form 460 Description of Eligibility and Registration Federal Government Form
Community Mental Health Center (CMHC) Checklist (Nov 2023).pdf Other-CMHC Checklist
Community Mental Health Center (CMHC) Checklist (Nov 2023).pdf Other-CMHC Checklist
Connected Care Pilot Program Instructions.pdf Instruction
Connected Care Pilot Program Instructions.pdf Instruction
Connected Care Pilot Program Questionnaire.pdf Other-Connected Care Pilot Program Q
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
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
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	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

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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	11,518	11,518
Annual IC Time Burden (Hours)	65,929	65,929
Annual IC Cost Burden (Dollars)	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.

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