Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Business or other for-profit Modified 11541 66115 0 Form N/A COVID-19 Telehealth Program Application Form
Instruction
Form N/A COVID-19 Telehealth Request for Reimbursement Form
Instruction
Other-Post Program Report Template
Federal Government Unchanged 11541 66116 0 Form FCC Form 460 Description of Eligibility and Registration
Other-CMHC Checklist
Other-Post Commitment Request Form
State, Local or Tribal Governments Unchanged 11541 66116 0 Other-COVID-19, Telehealth Program, LOA
Form FCC Form 461 Request for Services
Form FCC Form 462 Request for Funding
Form FCC Form 463 Description of Request for Funding Disbursement
Total burden requested under this ICR: 34623 198347 0  
To view an IC, click on IC Title