Rural Health Care Program Home

Forms

The forms may be revised each funding year. Applicants must use the correct funding year form to participate. Applicants are encouraged, if possible, to e-cert and submit their forms electronically.

Funding Year 2013

FCC Form 465

File Online

FCC Form 465

Description of Services Requested and Certification Form

FCC Form 465 Instructions

Community Mental Health Center Checklist

FCC Form 466

File Online

FCC Form 466

Funding Request and Certification Form

FCC Form 466 Instructions

FCC Form 466-A

File Online

FCC Form 466-A

Internet Service Funding Request and Certification Form

FCC Form 466-A Instructions

FCC Form 467

File Online

FCC Form 467

Connection Certification Form

FCC Form 467 Instructions

Funding Year 2012

FCC Form 467

File Online

2012 FCC Form 467

Connection Certification Form

2012 FCC Form 467 Instructions

Click here for Prior Year Forms.

Click here for Service Provider Forms (FCC Form 498, FCC Form 499-A/499-Q)