20140218Virgin Mobile Form 555.pdf

Kristin L. Jacobson, Counsel
201 Mission Street, Suite 1500
San Francisco, CA 94105
Tel: [phone] Fax: [phone]
Email: kristin.l.jacobson @sprint.com
?ti; Ir: i': i,l 2r c0
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Sprint
February 18,2O14
Jean Jewell (via email: [e-mail])
Commission Secretary
ldaho Public Utilities Commission
472W. Washington
Boise, !D 83702
RE: Virgin Mobile USA, L.P.'s Annual ETC Certification
Form (FCC Form 555) in Docket No. GNR-T-I4-01
Dear Ms. Jewell:
Accompanying this letter you will find Virgin Mobile USA, L.P.'s FCC Form 555 which was filed
with both the USAC and the FCC. Sprint is providing a copy of Form 555, as filed, to the ldaho
Public Utilities Commission for information purposes in Docket No. GNR-T-14-01. A hard copy
of this filing will be sent via U.S. Mail.
lf you have any questions or concerns regarding this form, I can be reached via email at:
Kristin.l.iacobson @sprint.com or via telephone al: 707-816-7583.
Warmest Regards,
/s/ Kristin L. Jacobson
Kristin Jacobson
FCC Form 555
December 2013
Approved by OMB
3060-08 I 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 FIRST
Deadline: January 3L't (Annually)
State
(An Eligible Telecommunications Carrier @TC) must provide a certification form for each state in which it provides Lifeline service).
479015 Virgin Mobile USA LP
ID
Study Area Code(s) (SAC)
Sprint Corporation
ETC Name(s)
Assurance Wireless
Holding Company Name(s)DBA, Marketing or Other Branding Name(s)
iliated ETCs (include names and SACs, attach
sheets if necessary)
Provide a list of all ETCs that are afiliated with the reporting ETC. Affiliation shall be determined in accordance with section 3(2) of the
Communications Act. That Section defines "afiliate" as "a person that (directly or indirectly) owns or controls, is owned or controlled by, or is
under common ownership or control with, another person." 47 U.S.C. S 153(2). See also 47 C.F.R. S 76.1 200.
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 1: All ETCs MUST COMPLETE SECTION 1- Initial Certiftcation
I certiff 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 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. Initial JF
FCC Form 555
December 2013
Section 2: All ETCs MUST COMPLETE SECTION 2-Annual ReceiliJicotion
Do not leave empty columns. If an ETC has nothing to report in a column, enter a zero.
Approved by OMB
3060-08 r 9
A B C
Number of
Subscribers Claimed on
February FCC Form(s) 497
ofcurrent 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
currcnt Form 555 calendar year
990 0 381
Initial the certiJications below that apply to your ETC and complete the tables corresponding to the certification below. Depending on
the state, BOTH CERTIFICATION A AND B MAyAPPLY.
A) I certify that the company listed above has procedures in place to recertiff 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 JF
D E F:D.E G 11= (p+G)
Number of
Subscribers ETC
Contacted Directly
to Reccrtify
Eligibility Through
Attestation
Number of
Subscribers
Responding to
ETC Contact
Number of Non-
Responding
Subscribers
Number of
Subscribers
Responding That
They Are No
Longer Eligible
Number ofSubscribers
De-enrolled or
Scheduled to be De-
Enrolled as a Result of
Non-Response or
Inelipibilitv
Number of
Subscribers Who
De.Enrolled Prior
to Recertification
Affempt
609 453 156 157 178
AND/OR
In the space below, please list the program eligibility data sources, such as ETC access to a state database and/or notice ofeligibility
from the state Lifeline administrator or the Universal Service Administrative Company (USAC) and indicatefor which qualifying
programs (e,9., SNAP, SSI) these sources are used to verify subscriber eligibility. If any of subscribers are subsequently contacted
directly by the ETC in an attempt to recertifu eligibility, those subscribers should be listed in columns D through I as appropriate and
not in columns J through L.
B) I certify that the company listed above has procedures in place to re-certify consumer eligibility by relying on
pr*ld.d t" th..h"rt b" make this
certification for the Study Area(s) listed above. Initial _
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
Recertifi cation Attempt
0 0 0
OR
C) I certify that my company did not claim federal low income support for any Lifeline subscribers for the February Form
497 datamonth for the culrent 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 _
FCC Form 555
December 2013
Section 3: ALL ETCS MUST COMPLETE SECTION 3 -De-enroll percentage
lYhat is the percentage of subscribers de-enrolledfor this ETC?
Approved by OMB
3060-08 l 9
M N o P=N+O Q=(P+M)*100)
Number of
Subscribers Claimed
on February FCC
Form(s) 497
(From Colwnn A)
Number ofSubscribers
De- Enrolled or
Scheduled to be De-
f,nrolled es a Result of
Non-Response or
Incligibility
(From Colwnn H)
Number ofSubscribers
De- Enrolled or
Scheduled to bc De-
Enrollcd as a Result of
r Finding of Incligibility
(From Column K)
Totrl Number of
Subscribers Dc-Enrollcd
or Scheduled to be De-E
nrolled
Perccntlge of Subscribers
Dc-Enrolled or Scheduled t<
be De-Enrolled that were
Claimed on the
February FCC Form(s) 497
990 157 0 157 l6Yo
Section 4: ALL ETCS MUST COMPLETE APPROPRIATE CHECK BOX; PRE.PAID ETCS MUST COMPLETE
ALL OF SECTION 4
Is the ETC Pre-Paid?
Yes Z frto l) (l fre-faid ETC does not assess or collect a monthlyfeefrom its Lifeline subsuibers)
If yes, record the number of subscribers de-enrolledfor non-usage by month in column S below.
Non-Usage Results Applicable to Pre-Paid ETCs:
R s
Month Subscribers De-Enrolled for Non-Usase
January 0
February 0
March 0
Anril 0
May 0
June I
July 6
August 2
September 4
October J
November I
December 5
Sisnature Block: ALL ETCS MUST COMPLETE SIGNATURE FIELDS
By signing below, I certiff 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
3060-0819FCC Form 555
December 2013
Signed,
Jay M. Franklin Jay M. Franklin
Signature of Officer
Assistant Controller
Printed Name of Officer
Jan-3 l-14
Title of Officer Date
Andy M. Lancaster 913-762-6107
Person Completing this Certification Form Contact Phone Number
FCC Form 555
December 2013
Approved by OMB
3060-08 I 9
ETC Identification
SAC ETC Name
479015 Virein Mobile USA LP
DBA, Marketi or Other Brandin
Holdin
Assurance Wireless
Approved by OMB
3060-081 9FCC Form 555
December 2013
Affiliated ETCs
SAC Name