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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
FCC Form 497
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 54.400-54.423
47 CFR 54.201-54.207
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
FCC Form 497
Lifeline Worksheet
FCC-Form-497.pdf
Yes
Yes
Fillable Fileable Signable
Form
FCC Form 5629
Lifeline Program Application Form
FCC-Form-5629.pdf
Yes
Yes
Fillable Fileable Signable
Form
FCC Form 5630
Lifeline Program Annual Recertification Form
FCC-Form-5630.pdf
Yes
Yes
Fillable Fileable Signable
Form
FCC Form 5631
Lifeline Program Household Worksheet
FCC-Form-5631.pdf
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Central Fiscal Operations
Privacy Act System of Records
Title:
FCC/WCB - 1, Lifeline Program
FR Citation:
82 FR 38686
Number of Respondents:
8,773,921
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
10,158,894
0
66
-1,818,233
0
11,977,061
Annual IC Time Burden (Hours)
5,486,320
0
66
-28,031
0
5,514,285
Annual IC Cost Burden (Dollars)
468,750
0
0
0
0
468,750
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.