20130131FCC Form 555 Potlatch Telephone Co.pdf

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January 29, 2013
Via 2-Day Mail
Ms. Jean D Jewell
Commission Secretary
Idaho Public Utilities Commission
472 W. Washington St.
Boise, ID 83720-5983
RE: Case # GNR-T-13-01
FCC Form 555 Annual Lifeline Eligible Telecommunications Carrier Certification
Form for TDS Telecom
Dear Secretary Jewell:
Attached please find a copy of TDS Telecom's Annual Lifeline Eligible
Telecommunications Carrier Certification Form (FCC Form 555) which was filed with the
Universal Service Administrative Company via email on January 29, 2013.
If you have any questions concerning this matter or regarding the attached information,
please contact me at 608-664-4148 or via e-mail at
jennifer. lautenschleqertdstelecom.com .
Sincerely,
nnifer
Regulatory Compliance Manager
Attachments
cc: Gail Long
535 JUNCTIONROAD
MADISON, W153717
P.O. BOX 5158
MADISON, WI 53705-0158

Approved by OMB
3060-0819
FCC Form 555
November 2012 7fl3JN31 Ptl 1:03

Annual Lifeline Eligible Telecommuu qainsCarue5r (1citification Form
All carriers must complete Sections 1, 2, and 3. Cãi+irs must complete Section 4, if applicable.
Deadline: January 31'(Annually)
1ctQo
State
(An Eligible Telecommunications Carrier (ETC) must provide a certflcationform for each state in which it
provides Lifeline service). 7 VL3O PC)+ 1i&fW'W_CD
Study Area Code(s) (SAC) ETC Name(s)
__ rc. 1DTi1im, TDS
Holding Company Name(s) DBA, Marketing or Other Branding Name(s)
Affiliated ETCs (include names and SACs,
attach additional sheets if necessary) hQL oi±.c1k&d
Section1: 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 stuay
areas within the state. Attach additional sheets if necessary).
AND/OR (A'&i.r4i aei' Pc cbiadkip
I certify that the company listed above confirms consumer eligibility by relying on CQe_.. b toiio &Wpx)
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 com a 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).
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 com 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
Wireline
Resellers
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
to Recertify
Eligibility Through
Responding to
ETC Contact
Subscribers Responding That
They Are No
Longer Eligible
Enrolled or
Scheduled to be
De-Enrolled as a
De-Enrolled Prior
to Recertification
Attempt
Attestation Result of Non-
Response or
Ineligibility p
I J K L
Number of Number of Customers De- Number of Subscribers Who De-Enrolled
Number of Subscribers Subscribers Whose enrolled or Scheduled to be De- 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 7 & i
Approved by OMB
3060-0819
FCC Form 555
November 2012
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 spec ific SAC(s) for which you are making this cert ification if it is not applicable to all of your study
areas within the state. Attach additional sheets if 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 c
above. Initial
!menamed above. I am authorized to make this certification for the Study Area(s) listed
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-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, /_•\ 7'
;5k~z~—
Signature of Officer
Kevin Hess
Printed Name of Officer
Senior Vice-President - Government & Regulatory Affairs January 28, 2013
Title of Officer Date
Jennifer R Lautenschleger 608-664-4148
Person Completing this Certification Form Contact Phone Number
FCC Form 555
November 2012
ETC Identification
SAC Name
472230 Potlatch Telephone Co.
Approved by OMB
3060-0819
Holding Company Name(s)
L)A, Marketing or Other branding Name(s)
FCC Form 555 Approved by OMB
November 2012 3060-0819
Affiliated ETCs
SAC Name
190217 Amelia Telephone Corporation
300585 Arcadia Telephone Company
452171 Arizona Telephone Company
361350 Arvig Telephone Company
532404 Asotin Telephone Company
522404 Asotin Telephone Company
330844 Badger Telecom, LLC
230469 Barnardsville Telephone Company
330849 Black Earth Telephone Company, LLC.
220346 Blue Ridge Telephone Company
330851 Bonduel Telephone Company, LLC.
361362 Bridge Water Telephone Co
330856 Burlington Brighton & Wheatland Telephone Company LLC
250284 Butler Telephone Company, Inc.
280448 Calhoun City Telephone Company, Inc.
220351 Camden Telephone and Telegraph Company, Inc.
320744 Camden Telephone Company, Inc.
330859 Central State Telephone Company, LLC
310685 Chatham Telephone Company
401698 Cleveland County Telephone Company, Inc.
100005 Cobbosseecontee Telephone Company
320776 Communications Corporation of Indiana
310672 Communications Corporation of Michigan
320809 Communications Corporation of Southern Indiana
290559 Concord Telephone Exchange, Inc
300607 Continental Telephone Company
401699 Decatur Telephone Company, Inc.
462184 Delta County Tele-Comm, Inc.
150089 Deposit Telephone Company, Inc.
330875 Dickeyville Telephone LLC
330914 EastCoast Telecom of Wisconsin, LLC
150092 Edwards Telephone Company Inc
330880 The Farmers Telephone Company LLC
330930 Grantland Telecom, LLC
100010 Hampden Telephone Company
542321 Happy Valley Telephone Company
100011 Hartland & St Albans Telephone Company
532377 Home Telephone Company
320777 The Home Telephone Company of Pittsboro, Inc.
320778 Home Telephone Company, Inc.
542322 Hornitos Telephone Company
290566 Humphreys County Telephone Company
310677 Island Telephone Company
120045 Kearsage Telephone Company
361413 KMP d/b/a Mid-State Telephone Company
260411 Leslie County Telephone Company
522427 Lewis River Telephone Company, Inc.
260412 Lewisport Telephone Co.
FCC Form 555 Approved by OMB
November 2012 3060-0819
Affiliated ETCs
SAC Name
300613 Little Miami Communications Corporation
140058 Ludlow Telephone Company
170183 Mahanoy & Mahantango Telephone Company
240533 McClellanville Telephone Company, Inc.
522430 McDaniel Telephone Company
320788 The Merchants and Farmers Telephone Company
123321 MCTA
120047 Merrimack County Telephone Company
432010 Mid-America Telephone, Inc.
330881 Mid-Plains Telephone, LLC
361433 Mid-State Telephone Company
330909 Midway Telephone Company LLC
330917 Mt. Vernon Telephone Company, LLC
330915 Mosinee Telehphohe Company
287449 Myrtle Telephone Company, Inc.
220375 Nelson-Ball Ground Telephone Company
193029 New Castle Telephone Co
421928 New London Telephone Company
140061 Northfield Telephone Company
240535 Norway Telephone Co Inc
250311 Oakman Telephone Company, Inc.
300645 Oakwood Telephone Company
431984 Oklahoma Communication Systems Inc
421934 Orchard Farm Telephone Company
150114 Oriskany Falls Telephone Corporation
250314 Peoples Telephone Company, Inc.
140062 Perkinsville Telephone Company, Inc.
150118 Port Byron Telephone Company
472230 Potlatch Telephone Company, Inc.
210338 Quincy Telephone Company
220338 Quincy Telephone Company
330943 Riverside Telecom, LLC
320816 S & W Telephone Company, Inc.
260417 Salem Telephone Co.
230498 Saluda Mountain Telephone Co.
330945 Scandinavia Telephone Company LLC
230500 Service Telephone Co
310726 Shiawassee Telephone Company
100024 Somerset Telephone Company
283301 Southeast Mississippi Telephone Company, Inc.
330952 Southeast Telephone Co. of Wisconsin, LLC
452174 Southwestern Telephone Company
240544 St. Stephen Telephone Company
330955 State Long Distance Telephone Company
330954 Stockbridge & Sherwood Telephone Company, LLC
421951 The Stoutland Telephone Company
462207 Strasburg Telephone Company
170206 Sugar Valley Telephone Company
FCC Form 555 Approved by OMB
November 2012 3060-0819
Affiliated ETCs
SAC Name
290578 Tellico Telephone Company, Inc.
290575 Tennessee Telephone Company
330958 Tenney Telephone Company, LLC
100007 The Island Telephone Company
300662 The Vanlue Telephone Company
320829 Tipton Telephone Company, Inc.
150129 Township Telephone Company, Inc.
320830 Tr-County Communications Corporation
120049 Union Telephone Company
330963 Utelco, LLC.
150133 Vernon Telephone Company, Inc.
190253 Virginia Telephone Company
100031 Warren Telephone Company
330968 Waunakee Telephone Company, LLC.
100034 The West Penobscot Telephone and Telegraph Company
320837 West Point Telephone Company
240551 Williston Telephone Company
120050 Wilton Telephone Company Inc
361507 Winsted Telephone Company
542323 Winterhaven Telephone Company
310738 Wolverine Telephone Company
432034 Wyandotte Telephone Company