The FCC seeks approval to: (1) extend some of the existing information collection requirements for the Healthcare Connect Fund and Telecommunications (Telecom) Programs; (2) revise some of the information collection requirements for the Healthcare Connect Fund and Telecom Programs and (3) add some new information collection requirements applicable to both the Healthcare Connect Fund Program and the Telecom Program as a result of the 2019 Promoting Telehealth Report and Order. The FCC also seeks approval to reformat and revise the Telecom Program Invoice Template and create a new Post-Commitment Request Form consistent with the changes adopted in the 2019 Promoting Telehealth Report and Order and to promote transparency into the RHC Program procedures and requirements.
The latest form for Universal Service - Rural Health Care Program expires 2023-05-31 and can be found here.
Document Name |
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Form and Instruction |
Supporting Statement A |
Federal Enterprise Architecture: Health - Health Care Services
Form FCC Form 466 | RHC, Telecommunications Program, Description of Request for Funding (FY2021+) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 466 | RHC, Telecommunications Program Description of Request for Funding (FY2020) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 465 | RHC, Telecommunications Program Description of Eligibility and Request for Services (FY 2021+) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 467 | RHC, Telecommunications Program, Connection Certification Form (FY2020+) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 462 | RHC, HCFP, Description of Request for Funding (FY2020+) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 461 | RHC, HCFP, Description of Request for Services (FY2021+) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 465 | RHC, Telecommunications Program, Description of Eligibility and Request for Services (FY2020) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 463 | RHC, HCFP, Description of Request for Funding Disbursement (FY2021+) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 463 | RHC, HCFP, Description of Request for Funding Disbursement (FY2020) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 461 | RHC, HFCP, Description of Request for Services (FY2020) | Fillable Fileable Signable | Form and instruction |
Form FCC Form 460 | RHC, HCFP, Description of Eligibility and Registration | Fillable Fileable Signable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.