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:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
47 CFR 54.601-54.679
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Checklist
0804_Attachment 1 - Community Mental Health Center Checklist_062813.docx
Yes
Yes
Fillable Fileable Signable
Other-Excel spreadsheet
0804_Attachment 2 - Telecom Program Invoice Template_062813.xls
Yes
Yes
Fillable Fileable Signable
Other-Excel spreadsheet
0804_Attachment 3 - RHC Pilot Program Invoice Template_062813.xls
Yes
Yes
Fillable Fileable Signable
Other-Excel spreadsheet
0804_Attachment 4 - FCC 465 Attachment Spreadsheet_062813.xls
Yes
Yes
Fillable Fileable Signable
Other-Template
0804_Attachment 5 - Letter of Agency Template_062813.doc
Yes
Yes
Fillable Fileable Signable
Other-Template
0804_Attachment 6 - Transfer of Letter of Agency Template_062813.docx
Yes
Yes
Fillable Fileable Signable
Other-Excel spreadsheet
0804_Attachment 7 - FCC 466-A Attachment Spreadsheet_062813.xls
Yes
Yes
Fillable Fileable Signable
Other-Excel worksheet
0804_Attachment 8 - Network Cost Worksheet_062813.xls
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:
3,666
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
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
-6,433
0
0
24,448
Annual IC Time Burden (Hours)
21,847
0
-7,051
0
0
28,898
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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