20150126Albion Telephone Company 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, !D 83311
January 19,2015
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.
FCC Form 555
November 2014
Approved by OMB
3060{819
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 31't (Annaally)
Does the reporting company have affiliated ETCs? Yes @ No @
Provide a list ofall ETCs that are aJliliated with the reporting ETC, using page 4 and additional sheets ifnecessarl,. AJJiliation shall be
determined in accordance with Section i(2) of the Communications Act. That Section defines "alfiliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common ownership or contrcl with, another person." 47 U.S.C. S 153(2). See also 47
c.r.R. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
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 sigrr the certification.
Section l: Initial Certification All ETCs must complete this section
I certify that the company listed above has certification procedures in place to:
A) Review income and program-based eligibility documentation prior to enrolling a consumer in the Lifeline prograr4 and
that, to the best of my knowledge, the conpany was presented with documentation of each consumer's household
income and/or program-based eligibility prior to his or her enrollment in Lifeline; and/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 authoriz.ed to rnake this certification for the Study Area Code listed
above,
Initiat RR
472213
StudyArea Code (SAC)
(An Eligible Telecommunications Carrier @TC) must provide a certificationformfor each SAC through which it proides Lifeline seruice).
lD Albion Telephone Company !nc.
State
ATC Communications
ETC Name
N/A
DBA. Marketins or Other Brandins Name(fsamb as ETC naie, list "N/A" Do not leive btank)
Holding Company Name(f same as ETC nane, list "N/A" Do not leave blank)
FCC Form 555
November 2014
Section 2: Annual Recertification
Do not leave empty blocles. If an ETC has nothing to report in a block, enter a zero.
Recertification Results:
K L
Number of
subscribers whose
eligibility was
reviewed by state
administrator,
ETC access to eligibility
database, or by 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
eligibility database, or USAC
133 0
Notez If any subscriber was reviewed by an ETC accessing a state database or
by a state administrutor and subsequently contacted directly by the ETC in an
attempt to recertify eligibility, those subscribers should be listed in Blocl<s F
through J as appropriate and not in Blocl<s K and L. As a result, all subscribers
subject to recertification who were not de-enrolled prior to the recertiJication
attempt must be accounted for in Block F or Block K.
The total ofBlock F and Block K should equal the number reported in Block
E.
support for any Lifeline subscribers for the February
I am an officer ofthe company named above. I am
Approved by OMB
3060{819
Certification:
Based on the data entered above, initial the certifi.cation(s) below that apply. Both Certification A and B may applv depending on the recertifcation
procedures in place for the SAC reporting on this fornt. lf Certification C applies, neither Certification A nor B may apply.
A.) I certiff that the company listed above has procedures in place to recertify 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 above in Blocks F
through J. I am an officer of the cornpany named above. I am authorized to make this certification for the SAC listed
above.Initial
Ar\D/oR
B.) I certify that the company listed above has procedures in place to recertify consumer eligibility by relying on:
Irlqhn T ifelino Ar{min f'tenf nf I{,&\l/. Results are provided in the chart above tn
Blocks K through L. I am an officer of the company named above. I am authorized to make this certification for the
SAC listed above.
Initial RR
OR
C.) I certify that my company did not olaim federal low income
Form 497 data month for the curent Form 555 calendar year.
authorized to nr,ake this certification for the SAC listed above.
Initial
A B c D E = (A_B_C_D)
Number of subscribers
clainrcd on February
FCC Form497 of
current Form 555
calendar year
(February data month)
Number of lines
clainrcd on February
FCC Form497 of
current Form 555
calendar year
provided to wireline
resellers
Number of subscribers claimed on the
February FCC Form 497 that were
initiallv enrolled in the current Form
555 calendar year
(These subscribers did not have Lifeline
service prior to January I oflhe current 555
calendar yean)
Number of subscribers
de-enrolled pdgl to
recertification atterpt
by either the ETC, a
state administrator,
access to an eligibility
database, or by USAC
Number of
subscribers ETC is
responsible for
recertiSing for
current Form 555
calendar year
133 0 17 0 116
F G H = (F-G)I s = 1H+r)
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 eligible
(This shoald be a subset of Bbck
G-)
Number of subscribers de-
enrolled or scheduled to be
de-enrolled as a result of
non-response or response of
ineligibility from ETC
recertifi cation attempt
0 0 0 0 0
FCC Form 555
November 2014
Section 3: De-enroll Percentage
Using the data entered in Section 2, complete the chart below to find the percentage ofsubscibers de-enrolledfor this ETC.
y =(F+K)N = (J+L)O=(N+M)*100)
Number of subscribers that the
ETC attempted to recertify directly
gg through a state administrator,
ETC access to a state database, or
by USAC
(This should equal the number
reported in Block E)
Number of
subscribers de-
enrolled or scheduled
to be de- enrolled as a
result of non-response
or ineligibility
Percentage of subscribers
de-enrolled or scheduled to
be de-enrolled as a result of
ineligibility or non-response
133 0 0.0%
Section 4: Pre-Paid ETCs
All ETCs must complete the appropriate check-box; pre-paid ETCs must complete all ofSection 4. Pre-paid ETCs generally ls not assess or collect a
monthlyfeefromtheirLifelinesubscibers. ETCsthatonlyassessafeebutdonotcollectsuchfeesarepre-paidETCsandmustcompletethe
chart below.
Is the ETC Pre-Paid?Yes [O No [G[
IJ'Yes, record the number of sttbscribers de-enrolled for non-usage by month in Block Q below.
Signature Block
Approved by OMB
30604819
P 0
Month Subscribers De-Enrolled for Non-Usaee
January 0
February 0
March 0
April 0
Mav 0
June 0
July 0
August 0
September 0
October 0
November 0
December 0
Total Subscribers 0
By signing below, I certi$r that the conpany listed above is in conpliance with all federal Lifeline certification
procedures. I am an officer of the conpany named above. I am authorized to rnake this certification for the
Study Area Code (SAC) listed above.
Rich RedmanNice President
[e-mail]
Email Address ofOfficer
Julie Laumb
Person Cornpleting This Certification Form
Printed Name and Title of Officer
01t19t2015
Date
208-673-5335
Contact Phone Number
Signature of Officer
3