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.

HCF Program Forms

FCC Form 460
File Online
Eligibility and Registration Form
Community Mental Health Center Checklist
FCC Form 461
File Online
Request for Services Form
FCC Form 462
File Online
Funding Request Form
FCC Form 463
File Online
Invoice and Request for Disbursement Form

 

Telecom Program Forms

FCC Form 465
File Online
Description of Services Requested and Certification Form
Community Mental Health Center Checklist
FCC Form 466
File Online
Funding Request and Certification Form
FCC Form 467
File Online
Connection Certification Form

 

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 at RHC-Assist@usac.org or at (800) 453-1546 to make alternative arrangements.