20140131Inland Telephone Form 555.pdf

INLAND TELEPHONE COMPANY
Corporale O{fices
,O3 S" 2nd Sr.
P.O. Box 171
Roslyn, WA 98941
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ri I
INLAND
TELEPHONE
Telephone: [phone] I
Fax: [phone]
Januar5r 3A,2Ol4
Vla email in .PDF format to [e-mail]
Idaho Public Utilities Commission
Commission Secretary
472 W. Washington
P.O. Box 83720
Boise, ID 8372O-OO74
Re: Pursuant to IPUC Order No. GNR-T-14-01
2014 Federal Lifeline Certification and Reporting
Pursuant to 47 C.F.R. S 54.416(b)
Dear Commission Secretary:
Pursuant to 47 C.F.R. S 54.416(b), accompanying this letter for
filing with the Idaho Public Utilities Commission ("Commission") is a copy
of the completed FCC Form 555 (Annual Lifeline Eligible
Telecommunications Carrier CerLification Form), for the reporting year
ended December 3L, 2013, that has been submitted by Inland Telephone
Company ("Company''XSAC 472423) to the Universal Service
Administrative Company (USAC) with respect to the Company's Lifeline
serwice subscribers residing in the State of ldaho.
Please let us know if the Commission has any questions regarding
the information presented on the accompanying form.
Sincerely,L%
James K. Brooks
Treasurer/Controller
Accompanying document
FCC Form 555
December 2013
Approved by OMB
3060-08 l9
Annual Lifeline Eligible Telecommunications Carrier Certification Form
All cariers 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 FIRST
Deodline: January 3In (Annuatly)
ldaho
State
(An Eligible Telecomnrunications Carrier (ETC) nuut provide a certificationformfor each state in which it provides Lileline senice).
472423 lnland Telephone Company
Study Area Code(s) (SAC)
Westem Elite lncorporated Services
Holding Company Name(s)DBA, Marketing or Other Branding Name(s)
Affiliated ETCs (includencones and SACs,atlach See list of Affiliated ETC'sadditional sheets if necessary)
Provide a list olall ETCs that are at/iliated vith the reporting ETC. Allilialion shall be determined in occordance with section jQ) of the
Comnunications Act. That Section defnes "afiiliate" as "a person thal (directly or indireclly) ovns or controls, is ovned or conlrolled by, or
is under common ovnership or eontmlwith, another person." 17 U,S,C, S 153@. See also 17 C.F.R S 76.120A.
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. lf the filer is a sole proprietorship, the owner must sign the
certification
Section 1: All ETCs MAST COMPLETE SECTION 1- Initiol CertiJication
I certif 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 and/or 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 eligibiliff from the
state Lifeline administrator prior to enrolling a consumer in the Lifeline program.
ETC Name(s)
lnland Networks
I am an officer of the c/qf,lpany named above. I am authorized to make this certification for the Study Area(s)
listed above. laitir,l {1p
II
Approved by OMB
3060-0819FCC Form 555
Dcember 2013
Section 2: AII ETCs MUST COMPLETE SECTION 2-Annual RecertiJication
Do not leave enrpty colunms. If an ETC has nothing lo rcport in a column, enter a zero.
A B C
Numbcr of
Suhsrrlbcrs Chlmrd on
Fcbruary FCC Form(s) 497
ofrurrcrl Form 555
calcndrr ycar
Numbcr of Lincs Ctllmcd oo
Fcbrurry FCC Farn(r) 497
ofcurrcnt Form555
calcndrr ycrr provlded to
\Ylrtllnc Reccllers
Nrmbcr of Subscrlben clalmtd
on lhc Fcbruary FCC Form(s)
497 thrl wcrc inilially cnrollcd ir
currcrt Form 555 celcndarycar
5 0 0
Initial the cerlifications belov that apply to your ETC and complete the lables corresponding to the certiJicalion belou,. Dependhtg
on Ihe sqaIe, BOTH CERTIFICATION A AND B IvUY APPLY,
A) I certifr that the company listed above has procedures in place to recertifo the continued eligibility of all of its
Lifeline subscribers, and that, to the best of my knowledge, the company 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 g:1r+G)I
Number of
Subecribcrs ETC
Contactcd Directly
to Recertify
Eligibility Through
Attcstation
Number of
Subscribcrs
Rcspondiag to
ETC Contact
Number ofNon-
Responding
Subscribcrs
Number of
Subscribers
Rerpoading That
Thcy Arc No
Longer Eligihlc
Numbcr ofSubscriberg
De-cnrolled or
Schcdulcd to bc De.
Enrollcd ss a Rcsult of
Non-Responsc or
Inclisihilitv
Number of
Subscribcn Who
De-Enrolled Prior
to Rcccrtificalion
Attempt
AND/OR
In lhe space below, please lisl the program eligibility dala Eor,lrces, such qs ETC access to a state database and/or notice of
eligibilityfronr the state Lifeline adninistralor or the Universal Service Adntinislrative Contpony (USAC), and indicate fot'which
qualifiing progrants (e.g., SNAP, SSI) these sources are used to vetih subscriber eligibility. If any of subsuibers are
subsequenlly contacted directly by the ETC in an attempl lo recertify eligibility, those subscribers should be listed in colwnns D
lhrough I as appropriate and not in columru J through L
B) I certifr that the company listed above has procedures in place to re-certify consumer eligibility by relying on
Community Action Parlnership Association (CAPA) of ldaho . Results are
provided in the chart below. I am an ofTicer of the above. I am authorized to make this
certification for the Study Area(s) listed above. Initial
OR
C) I certifr that my company did not claim federal low income support for any Lifeline subscribers for the February
Form 497 data month for the current Fonn 555 calendar year. I am an officer of the company named above. I am
authorized to make this certification for the Study Area(s) Iisted above. Initial _
Number ofSubscriberg
lVhose Eligibility was
Rcvierycd By Strtc
Administrator
ETC Access to Eligibility
Data or bv USAC
Numbcr of
Subscribcrs De-Enrolled or
Scheduled to bc De.Enrolled as r
Result of Finding of Incligibility by
State Administralor, ETC Acccsg lo
Eligibility Drta or USAC
Number of Subscribers Who
Dc-Enrollcd Prior to
Rceertificntion Attcmpt
Approved by OMB
3060-08 I 9FCC Form 555
December 2013
Section 3: ALL ETCS MUST COMPLETE SECTION 3 - De-enroll percentage
llthat is the percentoge of subscrlbers de-enrolled for this ETC?
Section 4: ALL ETCS MUST COMPLETE APPROPRIATE CHECK BOX; PRE-PAID ETCS MUST
COMPLETE ALL OF SECTION 4
Is the ETC Pre-Paid?
,* f] *" V (A Pre-Paid ETC does not assess or collect a monthtyfeefrom its Lifeline stbscribers)
If yes, record the number of subscribers de-enrolledfor non-usage by month in column S below.
Non-Usage Results Appllcable to Pre-Poid ETCs:
R s
Month Subscribers De.Enrolled for Non-Usase
January
February
March
Aoril
Mav
June
Julv
August
September
October
November
December
Sienature Block: ALL ETCS MUST COMPLETE SIGNATURE FIELDS
By signing below, I certifu that the company listed above is in compliance with all federal Lifeline certification
procedures. I anr an officer of the company named above. I am authorized to make this certification forthe Study
Area(s) listed above.
M N o P= N+O O=((P+llllrl00)
Number of
Suhacribrn Claiocd
on Fcbrurry FCC
Form(s) {97
(From Column A)
Numbcr ofSubscribcrs
Dc- Eurotlcd or
Sclcdulcd to bc Dc-
Enrolled ns e Rtsult of
Non-Rtsporrc or
Iurligibllity
(FrauColwnn H)
Numbcr ofSubrcrlbrrs
Dt- Enrollcd or
Scbcdultd lo bc Dc-
Enrollcd ls r Rrsull of
r Findtng of Iucligibility
(FmmColunm K)
Totel Numbcr of
Subscribcrr De-Errollcd
or Schcdulcd to bc Ile-E
nrolled
Pcrccolagc of Subscribrrs
Dc-Enrolled or Schcdulcd k
bc Dc-Enrollcd lbrt wcrc
Clalmcd oa thc
Februury FCC Form(s) 497
5 2 2 40
Approved by OMB
3060-08 I 9FCC Form 555
December 2013
Person Completing this Certification Form
Printed Name of Officer
01l30l2aA
James K. Brooks
Date
(5091649-2211
Contact Phone Number
Title of Officer
James K. Brooks
ETC Identification
SAC F.TC Name
47242?lnland Teleohone ComDanv
5U423 lnland TelEphone Company
479007 lnland Cellular LLC (f/k/a Washington RSA No. I L.P.)
529003 lnland Cellular LLC (f/Ua Washlngton ESA No. I L.P.)
5290Ort lnlend Cellular LLC (f/Ua Esstem Sub-RSA LP.)
dHol Namels
SAC Holdine Comoanv Name
472423 W€stem ElitB lncorporaled Sarvlce6
522423 Westom Ellte lncorporated Servlceg
479007 lnland Cellular Telephone Company
529003 lnland C6llular Telephone Company
529004 lnlend Cellular TelBohone Comoanv
DBA, Marketing or Other B Name[s
SAC Name
47242t lnland Networks
522423 lnland Notworks
479007 Inland C6llular
s29003 lntand Collular
529004 lnland CEllular
Approved by OMB
3060-081 IFCC Form 555
December 2013
Affiliated ETCs
SAC Name
522423 lnland TelephonB Company (d/b/a lnland Networks)
479007 lnland cellular LLc (frua WashinEton RSA No. 8 L.P.)(d/bla lnland Cellular)
52S003 lnland Cellular LLC (ilUa Washlnston RSA No.8 LP.Xdflr/a lfiland Callulat)
529004 lnland Csllular LLC (flUa Eestem Sub-RSA LP.Vdlb/a lnlsnd Ccllular)