20140130T-Mobile West LLC Form 555.pdf

iffi! ?ayr",H:?lJ
Suite 2400
1300 SW Fiflh Avenue
Portland, OR 91201-5630
Mark P. Trinchcro
[e-mail]
January 29,2014
YIA EMAIL - [e-mail]
Ms. Jean Jewell, Commission Secretary
Idaho Public Utilities Commission
PO Box 83720
472West Washington
Boise,lD 83702-0074
Re : T-Mobile West LLC - Form 555 Filing * Docket GNR-T-14-01
Dear Ms. Jewell:
On behalf of T-Mobile West LLC, enclosed for filing is FCC Form 555 pursuant to 47 CFR
$ s4.416(b).
Very truly yours,
Davis Wright Tremaine LLP
466-y-
Mark P. Trinchero
MPT/jan
Enclosure
DWT 23468245v1 00481 72-000324
I Anchorage I NewYork I Seattle
I B"llurr" I Po.ttuno I shanghat
I lsAnsoles I SanFrancisco I Washingtm,D.c.
I it, ., (1:;i
www.dwt,com
Approved by OMB
3060-0E19FCC Form 555
December 2013
Annual Lifellne Ellglble Teleconmunlcatlons Csrrier Cerllflcatlon Form
All cariers must compl€te atl or portions of all sections
Form must be submltted to USAC and filed rvlth the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deailllne:,Ian uary 3 ttt (Ann ually)
ldaho
State
(An EllgibleTcleconur.rrlcatlonscarlq (EIC) nu*pmvldeo cert{lcallonformf,oreachstale inwhlch tlproildes Llfeltne*ntice),
479013 T-Moblle West LLC
Study Area Code(s) (SAC)
T-Mobile USA, lnc.
ETCName(s)
T-Mobile
Holding Company Name(s)DBA, Marketing or Othet Branding Name(s)
Affillated ETCs (lnchde names and SACs, altach see attached rvorkshectaddilional sheets
Ptovkle a ilsl olall ETCI lhat oro qflilhtedvfth lhe reporttng ETC. $lllatlon shall be determlned ln acardance wlth sectton 3(2) olthe
Conmulcatlous Act. Tlnt Sectlou dctlnes "qfilllate" as "o person thal (dtnctly or lillrectly) owns u conlrols, ls owwd or controlled by, or
lswdercoumonownershlporconlrolwlth,anolherporson,"4TU,S,C.SlS3(2), Seeala47C,F,RS76,l200,
Forpurposes <if this filtng, an offlcer is an occupant of a posltion listed in the artiole of incorporation, articles of
formalion, or other sinilar legal documont An oflicer is a person who occupies a positlon specified in the oorpomto
by-larvs (or pafinership agreement), and would typically be president, vice president for operations, vice president for
frnance, compholler, treasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sign the
certificatlon
Section I ; l/I ETCI M UST COMPLE?E SECfl ON I- Intthl Certlflcot lon
I certify that lhe company listed above has certlfication procedures in place either to:
A) Roviol lncome and program-based eligibility documentation prior to enrolllng a consumer in the Lifeline
program, and that, to the best of my knowledge, the sompany was presented with dooumentation of each
consumer's household income and/or program-based eligibility prior to his or her effollment in Lifeline or
B) Con{irm consum€r ellgibility by relying upon access lo a state database and/or notice of eligibillty fiom the
state Lifeline administrator prior to eruolling a Gonsumer in the Lifeline program.
I am an officer oftho-company named above. I arn aulhorized to nrake this certification for tho Study Area(s)
listed above. Inlttalflfup\
Approved by OMB
3060-0819FCCForm 555
Dcember20l3
&clian 2: AA EfCs MUST COMPLETE SECIION 2- An n ud Recertltlcotlon
Do ttol leave erupty columns. Ilan ETC has nolhing lo repott in a columq enlet q zero,
A B c
Nunrbcr of
Subrcrlbrrc Chhuld on
Fcbrurry FCC Forn{s),197
ofcurrrt Forru 553
crlcDdff ycir
Nunrbcr of lJrcr (.'lrlnrd ou
Pcbruary FCC Form(i) .197
ofcurrelt Fornr 55S
crkodat,'.tr provldcd to
ll'hallBG R.rnll.r,
Nunlb* of Slbscrlbcrc chlrncd
oD lhc FcbrrNry FCC Forn(c)
,197 thel n'crc loldilly.orollcd ft
aurr.trt Fonn 555 crlcndrrycrr
l!0 3
Inlllal the cert{lcations below lhal aply to yur ETC utd complele ke lables cotrespondlng lo lhe certlticatlon belov. Dependhry
on Ifu *IaIe. BOTH CERTIFICATIONA AND B N,ilYAPPLT.
A) I certifr that the company listed above has procedures in place to recortify tho continued eligibility ofall ofits
Lifeline subscribers, and that, to the best of my knorvledge, tho company obtained signed certilications li'om atl
subscribers attosting to their continulng eligibility for Lifelino. Results are provided in the ohart below. I am an
officer pfthe company named above. I am authorized to ntako this csrtificalion for th€ Study Area(s) listed above,nlnttiatQd!\ *TrlbaL resldents only
D B F-D.E o rI=G+O)t
Nurnbcr of
$ubsglbcrcETC
Contrcled Dlrcctly
to Recertlf!
Ellglblllty Through
Allc.rtrllon
Numbcr of
Subrcrlbcru
Rccpondinl to
ETC Conlrcl
Nurnber of Nou.
Rcrpondlng
Subscriberc
Numbcrof
Subscrlbors
Rcspondlng Thnt
ThcyAroNo
Longer Ellglbls
Numbcr of Subscrlbcl's
llc-onrolled or
Sehciluled to be De.
Enrollcd rs a Resolt ol
Non-Responsc or
Inclleibilitv
Nunbsr of
Subscrlbers lVho
De.Enrolled Prlor
lo Rcccrtlllcrllon
AltemDt
I 1 0 0 0 a
AND/OR
In the space below, please list the program eltgtblllly dola sources, such 08 Erc qccess to a slate dalabose and/or nolice of
eltglbilityfi'ou the rtate Llfellt e admlnlstrator u' the Unlvercal Sentice ldminlstt atlve Company (USAC) and lndlcate tor which
qualifying prograns (e.g., SN/P, SSI) thwe sources ore used lo verlty subscrlber eltgtblllly. lf any of subsolbeff are
subsequently contacted dh'ectly by the ETC h at altenpt lo rccefllfy efiglbilily, lhose subscribers should be llsted ln colunns D
tlrough I as oppropriale ond not ht columns J lhrough L.
B) I certifl that the company listed above has procedures ln place to re'certlfy consumer eligibility by relying on
roucc ot cllglblllly lhottl slale admlnlstralor CAPAI for non.tlbal rocldonls lncludlng all qusllMng progfami managed by CAPAI , ResUlts Ue
provided In the ohart bolow. I am an officer of the company named above. I am authorized to make this
certification for the Study Area(s) listed above. Intttnl l[,[(
J K L
Numbor ofSubrcrlbcrr
lVhore El[lbllltywer
Rcvlerrcd Ey Stalc
Adnrlnlslrrtor
EIC Accoss to Ellglbillty
Drtn or bv USAC
Numbcr of
Subscrlberr llc-Enrolled or
Schedulcd to bc De-Enrollcd rr r
Itesult of Flndlng of Inellglblllly by
State Admlalrlmlor, ETC Acccsr to
Ellellrlllty Dntr or USAC
NumDcr oISubtcilDcrr lvno
IleEnrollcd Prlor lo
Rccsrtlfl catlon Altonpt
o 0 o
OR
C) I certify that my company did not claim federal lorv income suppofi for any Lifeline subscribers forthe February
Form 497 data month for the cuuent Form 555 calendar year. I am an oflicer of the company named above. I am
authorlzed to mako this certificatlon for the Shrdy Area(s) listed above, Inltlal-
Approved by OMB
3060-0819FCC Fonn 555
December 2013
Sectlon 3t ALL ETCS MUST COMPLETE SECTION 3 - De-enroll percent age
lYhot ls the percentoge of subscrlberc cle-enrolledfor thls ETC?
Sectlon 4: ALL BTCS MUST COMPLETB APPROPRIATE CHECK BOX; PRE-PAID ETCS MUST
COMPLETE ALL OF SECTION 4
Is the ETCPTe-Pakl?
,* [ *o V @ Pre-Patd EIC does not assess or collect a nonthlyfee!'om tu Llfeltne subswibers)
lf yes, record the number of substibers de-enrolledfor non-usage bynonth in colunn S below,
Non-Usage Results Appllcable lo Pre-Pold ETCI:
R s
Monfh Snhsarlherr De.Dnr.olled for Nan-flsnaa
Januarv
February
March
Aorll
Mav
June
lulv
August
Septembor
October
November
December
Signaturo Block: ALL ETCS MUSTCOMPLETE SIGNATURE FIELDS
By slgning bclorv, I certify that the company llsted above is in compliance rvith all federal Llfeline certification
procedures, I anr an officer of the conpany named above. I am authorizod to make this certification for the Study
Area(s) listed above.
I}I N o P=N+O ortrP+ilr*tnm
Numbrr of
Subrrlbcrr Chimcd
on Frbrurry FOC
Form(r).197
(FtouColuun 1)
Nunrbcr ofSubscdbrrs
Dc- Enrolltd or
Scbrduhd lo bc Dr.
ErrolltdmrRgullof
Nou.Rcspousc or
Iucl3glblllry
(FtouCohtttut II)
Numbar of Subs(rlblrs
Dr. Enrollrd or
Sohldulad to b! D..
Enroltcd ar r llcrul( ol
r Blodlug of Incllglblllty
(FlonrCohnnnK)
To(el Nurnbcr of
Subs*lbcrr Dc.Errollcd
or Schrdulcd lo bc Dc-E
nrollcd
Perttnlagc of Subscrtbcru
Dc.Eorollcd or Sctcdulcd tr
bc Dc.Enrollcd thnt wrre
Clllm.d on thc
Fcbrurry FCC Form(s) .197
11 0 0 0 0
Approved by OMB
3060.08 l9FCC Forn 555
Decomber 2013
Vice President, Tax
Title of Officor
Rhonda R. Thomas
Chrle Mlller
Prlnted Name of O$icer
Date425-383-4215 .. .
Contact Phone NumbetPorson Cornpleting this Ceftlflcation Form
ETC ldentification
sAc F.TCNnme
or Other Bra
FCC Form 555
December 2013
Afllltated ETCs
sAc Name
260042 (Alabamal T'Moblle Cent .l LLC and PowrrtouMomphb. lnc.
130006 (Connacllcull T-Moblle Norlhoagl LLC
589005 (Delawarc)T.Mobll6 Nodhcail LLC
579007 (olstdcl of Cotumur)T.MoblL Northaart LLc
210013 (Florld.)T.Moblta South tLC
229020 (Goorolal T-Moblle South LLC
820003 lHauraltl T-Moblle West LLC
470010 0daho)T-lr{obllo W63t LLC
e28015 (lndlana)T-trloblle Cenlral LLC
209024 0(antuckv)PoworiauMomphl6, lnc, aild T.illobllo Conlral LLC
2790116 il-oublanal T-Mobllo Cenlral LLC
189027 {MaMand)T-Moblle Nodhsist LLC
I I9004 (Masoachuscttl)T-Moblla Norlhoart LLC
910033 (Mlchloan)T-MobUo Contral LLC
3800{4 (Mlnnoola}T.Mobll6 Ccnt al LLC
2E9029 (Mleslcslpp0 PouortouMomphlr, lnc. and T-$loblte soulh LLC
429023 NlssourD T{,lobllo Contral LLC
120007 (New Hamoshlle)T.Mobllo Northoact LLC
{69004 (NewJercey)T-Mobllo Nodhor3l LLC
499013 tNew Mexlcol T.Moblle Wott LLC
160024 (N6wYork)T.Mobllo Nodhcart LLC
239005 (Nodh CaroInB)Sun0omWheless, lno.
300008 (Ohlo)T'Mobllo Conl al LLC and Volcoglrcam Plttsburgh LP
5300ltl (Oreoonl T'Mobllc W6st LLC
179014 lPonnsvlvanta)T-Moblle Northeast LLO, Volcosterm Pillrburoh LP andT.tirobllo Conlrat LLC
039003 Fuorto Rlcol T.MoDllo Puedo Rlco LLC
200022 (Tennosroo'l PoweileUMemohla. lno.
il4g086 (Toxas)T.MobUe Wosl LLO
lSS0l6(Vlrolnld T.Moblc Nodheast LLG
529013 M$hlnoton|T.Molllo Woet LLC