Rural Health Care
Forms
Please note that the RHC Program application forms, which expired on December 31, 2016, were replaced with new OMB-approved forms in My Portal on January 1, 2017. Applicants should refer to My Portal for the most up-to-date application forms. All HCF Program forms and supporting documentation must be submitted by filing online through My Portal.
FCC Form 460 |
Eligibility and Registration Form |
FCC Form 461 |
Request for Services Form |
FCC Form 462 |
Funding Request Form |
FCC Form 463 |
Invoice and Request for Disbursement Form |
Click here for Service Provider and Contributor forms (FCC Forms 498, 499-A/Q)
Applicants without adequate Internet access to submit the forms online should contact the RHC Help Desk via email or at (800) 453-1546 to make alternative arrangements.
