20140117ATC Communications Form 555.pdf

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p 208-673-5335 I t 208-673-6200 I e [e-mail] I a 225 W. North St. Albion, lD 83311
January !3,2074
Grace Seamons
ldaho Public Utilities Commission
PO Box 83720
Boise, lD 83720-0074
Dear Ms Seamons:
I am filing a copy of my FCC Form 555 which I have also filed with the FCC and USAC. lf you have any
questions or need additional information, please let me know.
Rich Redman
Vice President
FCC Form 555
December 2013
Approved by OMB
3060-08 1 9
Annual Lifeline Eligible Telecommunications Carrier Certification Form
All carriers must complete all or portions of all sections
Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS F'IRST
Deadline: January 31" (Annually)
State
(An Eligible Telecommunications Carrier (ETC) must provide a certificationforntfor each state in which it provides Lifeline service).
472213 Albion Telephone Company Inc
Study Area Code(s) (SAC)ETC Name(s)
ATC Communications
Holding Courpany Name(s)DBA, Marketing or Other Branding Name(s)
liated ETCs (include nanxes and SACs, attqch
tional sheets if necessary)
Provide a list of all ETCs that are affliated wilh the reporting ETC. Affiliation shall be determined in accordance witlt section 3Q) of the
Communications Act. That Section defines "ffiliate" as "a persotl that (directly or indirectly) owns or controls, is owned or conuolled by, or is
under common ownership or control with, another persott. " 47 U.S.C. I 153(2). See also 47 C.F.R. S 76.1200.
For purposes of this filing, an officer is an occupant of a position listed in the article of incorporation, articles of
formation, or other similar legal document. An officer is a person who occupies a position specified in the corporate by-
laws (or partnership agreement), and would typically be president, vice president for operations, vice president for
finance, comptroller, treasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sign the
certification
Section l: All ETCs MaST COMPLETE SECTION 1- Initial Certification
I certify that the company listed above has certification procedures in place either to:
A) Review income and program-based eligibility documentation prior to enrolling a consumer in the Lifeline
program, and that, to the best of my knowledge, the company was presented with documentation of each
consumer's household income andlor program-based eligibility prior to his or her enrollment in Lifeline or
B) Confirm consumer eligibility by relying upon access to a state database and/or notice of eligibility from the
state Lifeline administrator prior to enrolling a consumer in the Lifeline program.
I am an officer of the company named above. I am authorized to make this certification for the Study Area(s)
listed above. tnitial RR
ID
FCC Form 555
December 2013
Section 2: All ETCs MaST COMPLETE SECTION 2- Annuql Recertijication
Do not leave empty columns. If an ETC has nothing to report in a column, enter a zero.
Approved by OMB
3060-08 19
A B C
Number of
Subscribers Claimed on
February FCC Form(s) 497
of current Form 555
calendar year
Number of Lines Claimed on
February FCC Form(s) 497
ofcurrent Form 555
calendar year provided to
Wireline Resellers
Number of Subscribers claimed
on the February FCC Form(s)
497 that were initially enrolled in
current Form 555 calendar year
l3i 0 0
Initial the certifications below that apply to yotr ETC and complete the tables corresponding to the certifcation below. Depending on
the state, BOTH CERTIFICATION A AND B MAY APPLY.
A) I certify that the company listed above has procedures in place to recertifr the continued eligibility of all of its Lifeline
subscribers, and that, to the best of my knowledge, the compary obtained signed certifications from all subscribers
attesting to their continuing eligibility for Lifeline. 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 _
D E F =D-E G H: G+G)
Number of
Subscribers ETC
Contacted Directly
to Recertify
Eligibility Through
Attestation
Number of
Subscribers
Responding to
ETC Contact
Number of Non-
Responding
Subscribers
Number of
Subscribers
Responding That
They Are No
Longer EIigible
Number of Subscribers
De-enrolled or
Scheduled to be De-
Enrolled as a Result of
Non-Response or
Inelisibilitv
Number of
Subscribers Who
De-Enrolled Prior
to Recertification
Attempt
0 0 0 0 0 0
AND/OR
In the space below, please list the program eligibility data sources, such as ETC acceis to a state database and/or notice ofeligibility
from the state Lifeline administrator or the Universal Serttice Administrative Company (USAC) and indicatefor which qualifuing
programs(e.g.,SNAP,SSI)thesesourcesareusedtoverifysubscribereligibility. Ifanyofsubscribersaresubsequentlycontacted
directly by lhe ETC in an attempt to recertify eligibility, those subscribers should be listed in columns D through I as appropriate and
not in columns J through L.
B) I certifu that the company listed above has procedures in place to re-certiff consumer eligibility by relying on
Idaho Lifeline Adminstration from Department of Health & Welfare . 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
J K L
Number of Subscribers
Whose Eligibility was
Reviewed By State
Administrator
ETC Access to Eligibility
Data or bv USAC
Number of
Subscribers De-Enrolled or
Scheduled to be De-Enrolled as a
Result of Finding of Ineligibility by
State Administrator, ETC Access to
Elisibilitv Data or USAC
Number of Subscribers Who
De-Enrolled Prior to
Recerti{ication Attempt
131 15 0
OR
C) I certify that my company did not claim federal low income support for any Lifeline subscribers for the February Form
491 data month for the curent Form 555 calendar 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 _
Approved by OMB
FCC Form 555
December 2013
Section 3: ALL ETCS MUST COMPLETE SECTION 3 -De-enroll percentage
lVhat is the percentage of subscribers de-enrolled for this ETC?
3060-08 I 9
M N o P=N+O Q=(G+M)*loo)
Number of
Subscribers Claimed
on February FCC
Form(s) 497
(From Column A)
Number ofSubscribers
De- Enrolled or
Scheduled to be De-
Enrolled as a Result of
Non-Response or
Ineligibility
(From Colurnn H)
Number ofSubscribers
De- Enrolled or
Scheduled to be De'-
Enrolled as a Result of
a Finding of Ineligibility
(From Colunu K)
Total Number of
Subscribers De-Enrolled
or Scheduled to be De-E
nrolled
Percentage of Subscribers
De-Enrolled or Scheduled to
be De-Enrolled that were
Claimed on the
February FCC Form(s) 497
l3t 0 15 15 1t%
SCCtiON 4: ALL ETCS MUST COMPLETE APPROPRIATE CHECK BOX; PRE-PAID ETCS MUST COMPLETE
ALL OF SECTION 4
Is the ETC Pre-Paid?
Yes Z Uo @ (l fre-faid ETC does not assess or collect a monthlyfeefrom its Lifeline subscribers)
If yes, record the number of subscribers de-enrolledfor non-usage by month in column S below.
Non-Usage Results Applicdble to Pre-Paid ETCs:
R S
Month Subscribers De-Enrolled for Non-IIsase
January
February
March
April
May
June
Julv
Ausust
Seotember
October
November
December
Sienature Blockt ALL ETCS MUST COMPLETE SIGNATURE FIELDS
By signing 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.
Approved by OMB
3060-08 l9FCC Form 555
December 2013
Signed,
Rich Redman
Signature of Officer
Vice President
Title of Officer
Julie Laumb
Person Completing this Certification Form
Printed Name of Officer
Jan-13-14
Rich Redman
Date
208-673-5335
Contact Phone Number
FCC Form 555
December 2013
Approved by OMB
3060-0819
ETC Identification
SAC ETC Name
472213 Albion Teleohone Comoanv Inc.
DBA, Marketin or Other tsra
ATC Communications
FCC Form 555
December 2013
Approved by OMB
3060-08 19
Afltliated [1ICs
SAC Name