All RHC program forms and supporting documentation must be submitted to USAC by filing online through My Portal. COVID-19 Telehealth Program applicants must use the FCC Form 460 below to seek an eligibility determination.
HCF Program Forms
|FCC Form 460
(COVID-19 Telehealth Program start here)
|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|
Telecom Program Forms
|FCC Form 465||Description of Services Requested and Certification Form|
|FCC Form 466||Funding Request and Certification Form|
|FCC Form 467||Connection Certification Form|
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.
Applicants without adequate Internet access to submit the forms online should contact the RHC Help Desk at RHC-Assist@usac.org or at (800) 453-1546 to make alternative arrangements.