20130201FCC Form 555 T-Mobile West LLC.pdf

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DavisWright
!! Tremaine LLP ':F.:s-i i.!fl:5
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Suite 2400
1300 SW Fifth Avenue
Portland, OR 97201-5630
Alan J. Galloway
503.778.5219 tel
503.778.5299 fax
alangalloway©dwt.com
c,ji --r- /3-01
February 1, 2013
VIA EMAIL ONLY
Jean D. Jewell, Secretary
Idaho Public Utilities Commission
472 West Washington
Boise, ID 83702-5983
Re: 2013 ETC-Lifeline Certification
Dear Ms. Jewell:
On behalf of T-Mobile West LLC ("T-Mobile"), attached please find a copy of T-Mobile's FCC
Form 555 certification form for Idaho, which is hereby submitted to the Idaho Public Utilities
Commission pursuant to 47 C.F.R. § 54.4 16(b).
Please let me know if you have any questions concerning the submission of the form.
Very truly yours,
Davis Wright Tremai
Alan J.'Galloway
Of Attorneys for T-Mobile West LLC
AJG/cap
DWT 21077316v1 0048172-000324
Anchorage New York Seattle
Bellevue Portland Shanghai
Los Angeles San Francisco Washington, D.C. www.dwt.com
Approved by 0MB
3060-0819
FCC Form 555
November 2012
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 31"(Annually)
Idaho
State
(An Eligible Telecommunications carrier (ETC) must provide a cerljflcallon form for each state in which it
provides L jfeline service).
479013 T-Mobile West LLC
Study Area Code(s) (SAC) ETC Name(s)
T-Mobile USA, Inc. 1-Mobile
Holding Company Name(s) DBA, Marketing or Other Branding Name(s)
I Affiliated ETCs (include names and SACS, Fse-eattachedattach additionalsheets if necessa;y) worksheet
Section 1: All ETCs (Initial the certification that applies to your ETC. Depending on the state, both
cerlj/Icalions 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 th company named above.
I am authorized to make this certification for the Study Area(s) listed above. muItIa1
(List the specific SAC(s) for which you are making this certjflca:ion till is not applicable to all ofyour study
areas within the state. Attach additional sheets jfnecessa,y).
AND/OR
I certify that the company listed above confirms consumer eligibility by relying on
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 qua!j/j'ing 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. !nitial ,4...
(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 jfnecessa ,y.
*Tribal residents only
Approved by OMB
3060-0819
FCC Form 555
November 2012
Section 2: All ETCs(Iniiial the ceri?flcallon that applies to your ETC, and (f applicable, complete columns A
through L the lab/es below. Attach additional sheets if necessaiy).
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 flom 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.
Iflitlal
A B
Number of Number of
Subscribers Lines
Claimed on Claimed on
MayFCC May FCC
Form(s) 497 Form(s) 497
Provided to
Wirdfine
Resellers
6
C D E =C-D F 0= (El-F) H
Number of Number of Number of Non- Number of Number of Number of Subscribers ETC Subscribers Responding Subscribers Subscribers Be- Subscribers Who Contacted Directly Responding to Subscribers Responding 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
Ineligibility
6 5 0 0 0 0
I I K L
Number of Number of Customers Do- 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 ass 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
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. Tam 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 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 company named above. I am authorized to make this certification for the Study Area(s) listed
above. Initial
Section 4: Non-Usage Applicable to Certain Pre-Paid ETC's (the ETC does not assess or collect a monthlyfee
from its L jfeline subscrlber.)(Record the number ofsubscribers de-enrolledfor non-usage by month In column N
below).
M N
Month Subscribers Dc-Enrolled for Non-Usage
January
February
March
April
May
June
July
August
September
October
November
December
Signed,
S(gnture of Officer
Vice President, Tax
Title of Officer
Rhonda R. Thomas
Person Completing this Certification Form
H. Skip Cornett
Printed Name of Officer
.1! 24 (i!
Date
425-383-4215
Contact Phone Number
Approved by OMB
3060-0819
FCC Form 555
November 2012
Affiliated ETCs
SAC Name
259042 (Alabama) 1-Mobile Central LLC and Powartellidemphls, Inc.
139005 (Conneclicut) 1-Mobile Northeast LLC
569005 (Delaware) T.Mobile Northeast ILC
579007 (District of Columbia) 1-Mobile Northeast ILC
219013 (Florida) 1-Mobile South LLC
229020 (Georgia) 1-Mobile South LLC
629003 (Hawaii) 1-Mobile Weal LIC
479013 (Idaho) 1-Mobile West LIC
329015 (Indiana) T-Moblle Central LW
269024 (Kentucky) Powertel/Memphls, Inc. and T-Mobile Central LIC
189027 (Maryland) T.Moblle Northeast LLC
119004 (Massachusetts) 1-Mobile Northeast LIC
319033 (Michigan) 1-Mobile Central LIC
369014 (Minnesota) T-Mobile Central LLC
289029 (Mississippi) Powertel/Memphls, Inc. and 1-Mobile Central LLC
429023 (Missouri) 1-Mobile CeIrøI LW
129007 (Mew Hampshire) 1-Mobile Northeast LLC
unassigned (New Jersey) T-Mobile Northeast LLC
499013 (New Mexico) 1-Mobile West LLC
159024 (New York) T-Mobile Northeast LIC
239005 (North Carolina) SunCom Wireless, Inc.
309008 (Ohio) 1-Mob1le Central LLC and VolceStream Pittsburgh LP
unassigned (Oregon) 1-Mobile West LLC
179014 (Pennsylvania) 1-Mobile Northeast LLC, VotceStroam Pittsburgh LP. and 1-Mobile Central LLC
639003 (Puerto Rico) 1-Mobile Puerto Rico LLC
299022 (Tennessee) PowertellMemphls, Inc.
449066 (Texas) 1-Mobile West tIC
199018 (VirginIa) 1-Mobile Northeast LLC
529013 (Washington) 1-Mobile West LW
279046 (Louisiana) 1-Mobile Central hG