Information Collection

FCC Form 555, Annual Lifeline Eligible Telecommunications Carrier Certification Form

IC 203941 under ICR 201308-3060-005 · OMB 3060-0819.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0819 can be found here:

Documents and Forms

Document Name Document Type
Form FCC Form 555 FCC Form 555, Annual Lifeline Eligible Telecommunications Carrier Certification Form Form and Instruction
FCC Form 555 Annual Lifeline Eligibility Telecommunications Carrier C 0819_FCC555_Revised_091412.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	FCC Form 555, Annual Lifeline Eligible Telecommunications Carrier Certification Form	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

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 555	Annual Lifeline Eligibility Telecommunications Carrier Certification Form	0819_FCC555_Revised_091412.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 940	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 35 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	940	0	940
Annual IC Time Burden (Hours)	15,040	940	14,100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.