20130128FCC Form 555 Albion Tel, ATC.pdf

A EC
Communications
p 208-673-5335 I f 208-673-6200 I e [e-mail] I a 225 W. North St. Albion, ID 83311
January 23, 2013
Grace Sea mons
Idaho Public Utilities Commission
P0 Box 83720
Boise, ID 83720-0074
Dear Ms. Seamons:
'R-i/3 C'j
C
UM n
j.j r) C) m
c9
I am filing a copy of my FCC Form 555 which I have also filed with the FCC and USAC. If you have any
questions or need additional information, please let me know.
Sincerely,
X 0-/~A--~
Rich Redman
Vice President
.,UT-'3 .I
RE CE v: Approved by OMB
3060-0819
FCC Form 555 71113 JAN 28 AN : 19
November 2012
Li, .
Annual Lifeline Eligible Telecommuniais Cai°rier Certificalion Form
All carriers must complete Sections 1, 2, and 3. Carriers must complete Section 4 if applicable.
Deadline: January 31(Annually)
ID
State
(An Eligible Telecommunications Carrier (ETC) must provide a certification form for each state in which it
provides Lifeline service).
472213 OLSON TEL. Co INCOb ETC COM
Study Area Code(s) (SAC)
Holding Company Name(s)
Affiliated ETCs (include names and SACs,
attach additional sheets if necessary)
ETC Name(s)
ATC Communications
DBA, Marketing or Other Branding Name(s)
Section 1: All ETCs (Initial the certification that applies to your ETC. Depending on the state, 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(s) for which you are making this certification if it is not applicable to all of your study
areas within the state. Attach additional sheets if necessary).
AND/OR
I certify that the company listed above confirms consumer eligibility by relying on Idaho Lifeline Administration from H&W
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 state Lifeline administrator and indicate for
which qualifying programs (e.g., SNAP, SSI) these sources are used to verify consumer eligibility). I am an
officer of the company named above. I am authorized to make this certification for the Study Area(s) listed
above. Initial RR
472213
(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 if necessary).
Approved by OMB
3060-0819
FCC Form 555
November 2012
Section 2: All ETCs(Initial the certification 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 listed above has procedures in place to re-certify the continued eligibility of all of its
Lifeline customers, and that, to the best of my knowledge, the company obtained signed certifications from all
consumers attesting to their continuing 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 were re-certified by the state Lifeline administrator. Results are provided in the chart below. I am an officer
of the company named above. I am authorized to make this certification for the Study Area(s) listed above.
Initial RR
A B
Number of Number of
Subscribers Lines
Claimed on Claimed on
May FCC May FCC
Form(s) 497 Form(s) 497
Provided to
Wireline
Resellers
0 0
C D E =C-D F G = (E+F) H
Number of Number of Number of Non- Number of Number of Number of
Subscribers ETC Subscribers Responding Subscribers Subscribers De- Subscribers Who
Contacted Directly Responding to Subscribers Responding That Enrolled or De-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
Ineligibility
0 0 0 0 0 0
J K L
Number of Number of Customers Dc- Number of Subscribers Who Dc-Enrolled
Number of Subscribers Subscribers Whose enrolled or Scheduled to be Dc- 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
164 164 0 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 ((necessary).
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 company named above. I am authorized to make this certification for the Study Area(s) listed
above, Initial RR
Section 4: Non-Usage Applicable to Certain Pre-Paid ETCs (the ETC does not assess or collect a monthly fee
from its Lifeline subscribers)(Record the number of subscribers de-enrolled for non-usage by month in column N
below).
M N
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
May 0
June 0
July 0
August 0
September 0
October 0
November 0
December 0
Signed,
RICH REDMAN RICH REDMAN
Signature of Officer Printed Name of Officer
VICE PRESIDENT Jan-23-13
Title of Officer Date
JULIE LAUMB 208-673-5335
Person Completing this Certification Form Contact Phone Number