20130125FCC Form 555 Direct Communications.pdf

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2013 JAIN 25 AM 10: 37 FCC Form 555
November 2012 AFi
LJTILtTIS COMMSO
Annual Lifeline Eligible Telecommunications Carrier Certification Form
All carriers must complete Sections 1, 2, and 3. Carriers must complete Section 4, if applicable.
Deadline: January 3fr(Annual4,)
IDAHO
State
(An Eligible Telecommunications carrier (ETC) must provide a certficationformJor each stale in which it
provides Lifeline service). DIRECT COMMUNiCATIONS
Study Area Code(s) (SAC) ETC Name(s)
Holding Company Name(s) DBA, Marketing or Other Branding Name(s)
Affiliated ETCs (include names and SACs,
attach additional sheets if necessary)
Section 1: All ETCs (Initial the certification that applies to your ETC. Depending on the stale, both
certifications may apply).
I certify that the company listed above has certification procedures in place to review income and program-based
eligibility documentation prior to enrolling a customer in the Lifeline program, and that, to the best of my
knowledge, the company was presented with documentation of each consumer's household income and/or
program-based eligibility prior to his or her enrollment in Lifeline. I am an officer of the company named above.
I am authorized to make this certification for the Study Area(s) listed above. Initial
(List the specific SAC(Y) for which you are making this certification if it is not applicable to all ofyour study
areas within the state. Attach additional sheets if necessary).
AND®
I certify that the company listed above confirms consumer eligibility by relying on CAPAI
prior to enrolling a customer in the Lifeline program. (Please list the program eligibility data sources, such as
ETC access to a state database and/or notice of eligibility from the stale Lifeline administrator and indicate for
which qualifying programs (e.g., SNAP, SSI) these sources are used to verjfv consumer eligibility), 1 am an
officer of the con aiy named above. I am authorized to make this certification for the Study Area(s) listed
above. Initial AP'
(List the specific SAC() for which you are making this certification if II is not applicable to all of your study
areas within the state. Attach additional sheets if necessary).
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3060-0819
FCC Form 555
November 2012
Section 2: All EIVs(Jnitial the cerli/ication that applies to your ETC and if applicable, complete columns A
through L the tables below. Attach additional sheets if necessary).
I certify that the company td above has procedures in place to re-certify the continued eligibility of all of its
Lifeline customers, and tlit. to the best of my knowledge, the company obtained signed certifications from all
consumers attesting to theircontinuing eligibility for Lifeline, except those subscribers whose eligibility was
verified by the company through the use of other sources of eligibility information as well as those subscribers
who
wJ~y
r ertified by the state Lifeline administrator. Results are provided in the chart below. 1 am an officer
of the c named above. I am authorized to make this certification for the Study Area(s) listed above.
Initial
A B
Number of Number of
Subscribers Lines
Claimed on Claimed on
May FCC May FCC
Form(s) 497 Form(s) 497
Provided to
Wirelinc
Resellers
67 0
C I D - E =C-D F 0= (E+F) H
Number of Number of Number of Non- Number of Number of Number of
Subscribers ETC Subscribers Responding Subscribers Subscribers Dc- Subscribers Who
Contacted Directly Responding to Subscribers Ràponding That Enrolled or Dc-Enrolled Prior
to Recertify ETC Contact They Are No Scheduled to be to Recertification
Eligibility Through Longer Eligible Dc-Enrolled as a Attempt
Attestation Result of Non-
Response or
lnligibiljty
0 0 0 0 0 0
I J K
- Number of Number of Customers Dc- Number of Subscribers Who The-Enrolled
Number of Subscribers Subscribers Whose enrolled or Scheduled to be The- Prior to Recertification Attempt
Whose Eligibility was Eligibility Was Enrolled as a Result of a Finding
Reviewed By State Examined by State of Ineligibility
Administrator or By Administrator or By
ETC Access to Eligibility ETC Access, to
Data Eligibility Data and
Found to be
Ineligible
65 36 36 0
Approved by OMB
3060-0819
FCC Form 555
November 2012
OR
I certify that my company did not claim federal Low Income support for any Lifeline customers prior to June *
(insert current year). I am an officer of the company named above. I am authorized to make this certification for
the Study Area(s) listed above. Initial -
(List the specific SAC(s) for which you are making this certification if it is not applicable to all ofyour study
areas within the state. Attach additional sheets fnecessary).
Section 3: All ETCs (Initial the certification below).
I certify that the company listed above is in compliance with all federal Lifeline certification procedures. I am an
officer of the cotpany named above. I am authorized to make this certification for the Study Area(s) listed
above. Initial U"
Section 4: Non-Usage Applicable to Certain Pre-PaidETCs (the ETC does not assess or collect a monthlyfee
from its Lifeline subscribers)(Record the number of subscribers de-enrolledfor non-usage by month in column N
below).
M N
Month Subscribers De-Enrolled for Non-Usage
January
February
March
April
May
June
July
August
September
October
November
December
Signed,
JEREMY SMITH
Printed Name of Officer
nEF
er
?N!A 1/24/2013
Title of Officer Date
LINDA RALPHS 208-548-2345
Person Completing this Certification Form Contact Phone Number