View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Universal Service - Rural Health Care Program
Agency IC Tracking Number:
WCB
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
47 CFR 54.600 - 54.680
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Template
0804_Attachment 9 - Certification of Program Participant Template_062813.doc
Yes
Yes
Fillable Fileable Signable
Other-Template
0804_Attachment 10 - Vendor Certification Template_062813.doc
Yes
Yes
Fillable Fileable Signable
Form
FCC Form 460
Eligibility and Registration Form
0804_Attachment 11_FCC Form 460_062813.pdf
Yes
Yes
Fillable Fileable Signable
Instruction
0804_Attachment 12_FCC Form 460 Instructions_062813.docx
Yes
Yes
Fillable Fileable Signable
Form
FCC Form 461
Healthcare Connect Fund Request for Services Form
0804_Attachment 13_FCC Form 461_062813.pdf
Yes
Yes
Fillable Fileable Signable
Instruction
0804_Attachment 14_FCC Form 461 Instructions_062813.docx
Yes
Yes
Fillable Fileable Signable
Instruction
0804_Attachment 15_FCC Form 462 Instructions_062813.docx
Yes
Yes
Fillable Fileable Signable
Form
FCC Form 462
Healthcare Conect Fund Funding Request Form
0804_Attachment 16_FCC Form 462 with NCW_062813.pdf
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:
3,667
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
98 %
Approved
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
18,015
0
0
0
0
18,015
Annual IC Time Burden (Hours)
21,847
0
0
0
0
21,847
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.
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