| 
                    
                        |  | Universal Service - Rural Health Care Program |  | WCB |  
                        |  |  
                        
                        
                        | No | Modified |  
                        |  |  
                        | Required to Obtain or Retain Benefits |  
                        |  |  
                        | 47 CFR 54.600 - 54.633 |  
 
			
				| Document Type | Form No. | Form Name | Instrument File | URL | Available Electronically? | Can Be Submitted Electronically? | Electronic Capability |  
				| Form and Instruction | FCC Form 460 | RHC, HCFP, Description of Eligibility and Registration | 2020 FCC Form 460 for OMB submission.11.7.19_RHC.effective upon OMB approval (4.3.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 461 | RHC, HFCP, Description of Request for Services (FY2020) | 2020 FCC Form 461 for OMB submission.11.7.19_RHC.effective FY2020 (4.3.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 463 | RHC, HCFP, Description of Request for Funding Disbursement (FY2020) | 2020 FCC Form 463 for OMB submission.effective FY2020.11.7.19 (4.7.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 463 | RHC, HCFP, Description of Request for Funding Disbursement (FY2021+) | 2020 FCC Form 463 for OMB submission.effective FY2021.11.7.19 (4.7.20) .docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 465 | RHC, Telecommunications Program, Description of Eligibility and Request for Services (FY2020) | 2020 FCC Form 465 for OMB submission.11.7.19_RHC.effective FY2020 (4.3.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 465 | RHC, Telecommunications Program Description of Eligibility and Request for Services (FY 2021+) | 2020 FCC Form 465 for OMB submission.11.7.19_RHC.effective FY2021 and beyond (4.3.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 466 | RHC, Telecommunications Program Description of Request for Funding (FY2020) | 2020 FCC Form 466 for OMB submission.11.7.19_RHC.effective FY2020 (4.3.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 466 | RHC, Telecommunications Program,  Description of Request for Funding (FY2021+) | 2020 FCC Form 466 for OMB submission.11.7.19_RHC.effective FY2021 and beyond (4.3.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 461 | RHC, HCFP, Description of Request for Services (FY2021+) | 2020 FCC Form 461 for OMB submission.11.7.19_RHC.effective FY2021 and beyond (4.3.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 462 | RHC, HCFP, Description of Request for Funding (FY2020+) | 2020 FCC Form 462 for OMB submission.11.7.19_RHC.effective FY2020 and beyond (4.3.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
				| Form and Instruction | FCC Form 467 | RHC, Telecommunications Program,  Connection Certification Form (FY2020+) | 2020 FCC Form 467 for OMB submission.11.7.19_RHC.effective FY2020 and beyond (4.3.20).docx |  | Yes | Yes | Fillable Fileable Signable |  
 
                
                    | Health | Health Care Services |  
 
                
                    |  |  |  
                	
                    	|  |  |  
 
                
                    | 3,498 | 0 |  
                    |  |  |  
                    | State, Local, and Tribal Governments |  |  
                    |  |  
                    | 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 | 31,229 | 0 | 1,467 | -9,252 | 0 | 39,014 |  
                    | Annual IC Time Burden (Hours) | 127,580 | 0 | 31,257 | 4,627 | 0 | 91,696 |  
                    | Annual IC Cost Burden (Dollars) | 0 | 0 | 0 | 0 | 0 | 0 |  
 
                
                    | Title | Document | Date Uploaded |  
                    	
                        	| No associated records found |  |