20130204FCC Form 555 TracFone Wireless, Inc.pdf

TRAC FNE
wireless, inc. 9700 NW 112th Avenue Miami, FL 331 78 rcrr
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January 31, 2013
VIA OVERNIGHT MALL
Jean Jewell, Secretary
Idaho Public Utilities Commission
472 W. Washington St.
Boise, ID 83720
Re: TracFone Wireless, Inc. - FCC Form 555 Report
Dear Ms. Jewell:
In accordance with the Federal Communication Commission's Lifeline Reform Order
and 47 CFR 54.4 16(b) please find enclosed a copy of the FCC Form 555 Report of TracFone
Wireless Inc. ("TracFone"). You may reach me at [phone] if you have any questions.
Sincerely,
Stephen Athanson
Regulatory Counsel
phone: [phone] www.tracfone.com www.netlO.com
Approved by OMB
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 31si(Annaally)
IDAHO
State
(An Eligible Telecommunications Carrier (ETc,) must provide a cert(fication form for each stale in which it
provides Lifeline service).
NOT AVAILABLE TracFone Wireless, Inc.
Study Area Code(s) (SAC) ETC Name(s)
Tracone Wireless, Inc. Safelink Wireless
Holding Company Name(s) DBA, Marketing or Other Branding Name(s)
Affiliated ETCs (include names and SAC's, N/A attach additional sheets jfnecessary
Section 1: A1IETCs (Initial the certjfication that applies to your ETC. Depending on the state, both
certj/Icafions 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 spec(/lc SAC(s) for which you are making this certification (fit is not applicable to all ofyour 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 - prior
to enrolling a customer in the Lifeline program. (Please list the program eligibility data sources, such as ETC
access to a slate database and/or notice of eligibility from the state Lifeline administrator and indicate for
which quali)j'ingprogra,ns (e.g., SNAP, 53)) 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
(List the spec (lie SAC(s) for which you are making this certification (fit is not applicable to all ofyour study
areas within the state. Attach additional sheets ((necessary).
Approved by OMB
3060-0819
FCC Form 555
November 2012
Section 2: All ETcs (n/flat the certification that applies to yow' ETC, and if applicable, complete
columns A through L the tables below. Attach additional sheets necessay).
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 veil 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
A B
Number of Number of
Subscribers Lines
Claimed on Claimed on
May FCC May FCC
Form(s) 497 Form(s) 497
Provided to
%VireIlne
Resellers
0 0
C B E =C-D F G = (J+F) H
Number of Number of Number of Non- Number of Number of Number of
Subscribers Subscribers Responding Subscribers Subscribers Be- Subscribers Who ETC Contacted Responding to Subscribers Responding Enrolled or Dc-Enrolled
Directly to ETC Contact That They Are Scheduled to be Prior to
Recertify No Longer Dc-Enrolled as a Recertification Eligibility Eligible Result of Non- Attempt Through Response or
Attestation Ineligibility
0 0 0 0 0 0
I J K L
Number of Subscribers Number of Subscribers Number of Customers Be- Number of Subscribers Who Be-
Whose Eligibility was Whose Eligibility %Vas enrolled or Scheduled to be Enrolled Prior to Recertification
Reviewed By State Examined by State Be-Enrolled as a Result of a Attempt
Administrator or By Administrator or By Finding of Ineligibility ETC Access to Eligibility ETC Access to Eligibility
Data Data and Found to be
Ineligible
0 0 0 0
Approved by OMB
3060-0819
FCC Form 555
November 2012
WS
I certify that my company did not claim federal Low Income support for any Lifeline customers
prior to June 2012 (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, g
(List the specific SAC(s)for which you are making this cerlVicahion if it is not applicable to all ofyour
study areas within the state. Attach additional sheets Ifnecessary).
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-PaidETCs (the ETC does not assess or collect a monthly
fee from its Lifeline subscribers)Record the number ofsubscribers 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
Approved by OMB
3060-0819
FCC Form 555
November 2012
Signed,
Signature of Officer
Sr. Officer —Alternative Business Units
Title of Officer
Javier Rosado
Printed Name of Officer
113 0 /;?- 0/3
Date
Janet Morejon [phone]
Person completing this Certification Form Contact Phone Number