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Home My WebLink About20150130CenturyLink CenturyTel of Idaho 555.pdfFCC Form 555 November 2014 Approved by OMB 30604819 Annual Lifeline Eligibte Telecommunications Carrier Certification Form All carriers must corplete all or portions of all sections Form must be submitted to USAC and filed with the Federal Communications Commission !!,IMPORTAIIT: PLEASE READ INSTRUCTIONS FIRST * Deadline: January 31n (Annually) E,.' il ",,.rrii :: ., :j\- , i r Does the reporting company have affiliated ETCs?Yes @l No [d Provide a list of all ETCs that are affiliated with the reporting ETC, using page 4 and additional sheets if necessary. Affliation shall be determined in accordance with Section 3(2) of the Communications AcL That Section deJines "afliliate" 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. $ 76.1200. Affiliated ETC's SAC Affiliated ETC's Name - See attached worksheet -- 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 tlpically 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 sigr the certification. Sectlon l: Initial Certification All ETCs must complete this section I certify that the conpany listed above has certification procedures in place to: A) Review income and program-based eligibility documentation prior to enrolling a consumer in the Lifeline progranr, 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 cornpany named above. I am authoriznd to make this certification for the Study Area Code listed above. lniti"t JMA 472225 StudyArea Code (SAQ - '_ f,.)(An Eligible Telecommunications Carier @TC) must provide a certi/icationformfor etch SAC through which it provides Eifeline semice). ID CenturyLink CenturyTel of ldaho llic. State CenturyLink ETCName CenturyLink, lnc. DBA. Marketins or Other Brandine Name(fsanb as ETC narie, list "N/A" Do not leive blank) Holding Company Name(lf sane as ETC name, list "N/A" Do not leave blank) FCC Form 555 November 2014 Section 2: Annual Recertification Do not leave empty blocks. If an ETC has nothing to report in a bloch enter a zero. Recertification Results : K L Nuder of subacribers whose eligiHlity was reviewed by strte administrator, ETC access to eligtHllty database, or by USAC Nuderof subscrlbem de.emolled or scheduled to be de-enrolled as a result offinding of lneltgiHlity by state admlnistrator, ETC access to eligtbility drtobase, or USAC 134 16 Note: If any subscriber was reviewed by an ETC accessing a state database or by a state administrator and subsequently contacted directly by the ETC in an attempt to recertify eligibility, those subscibers should be listed in Blocks F through J as appropriate and not in Blocls K and L. As a result, all subscibers subject to recertification who were not de-enrolled prior to the recertification attempt must be accountdfor in Block F or Block K. The tottl of Bloch F and Block K should qual the number reported in Bloch E. Approved by OMB 30604819 Certification: Based on the data entered above, initial rte certification(s) below that apply. Both Certification A and B may apply depending on the recerti/ication procedures in placefor the SAC reporting on thisform. If 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 sigred 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 corryany named above. I am authorized to make this certification for the SAC listed above. Initial AI{D/OR I certiff that the corpany listed above has procedures in place to recertify consumer eligibility by relying on: Commrrnitv Action Partnershin Association of Idaho (CAPAI) Results are provided in the chart above in 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. 1oi1i"1 JMA OR I certiff that my corpany did not claim federal low income support for any Lifeline subscribers for the February Form 497 data month for the culrent Form 555 calendar year. I am an officer of the conpany named above. I am authorized to make this certification for the SAC listed above. Initial B.) A B C D E = (A_B_C_ D) Nuder of subccrlberi claimed on Februory FCC Form497 of current Form 555 calendar year (February data month\ Number of lines claimd on February FCC Form497 of current Form 555 calendar year provlded to wirdine resellers Number of subscribers clalmed on the February FCC Form 497 that were inttlallv enrolled in the current Form 555 calendar year (These sabscribers did tut have Lifeline sertice pior to Jatuary I ofthe canent 555 cakndar year.) Nuder of subscrlbers deenrolledglqto recertification otteryt by either the ETC, a strte admlnistraton rc.ess to an ellgibillty drtabase, or by USAC Number of subscrlberc ETC is responsible for recertifying for current Form 555 calendar year 142 0 4 4 134 F G E =(F_G)I J = (H+r) Number of subscribers ETC contacted directly to recertify eliglbility throryh rttestadon Number of subscrib€n responding to ETC contrct Number ofnon respondlry subacrlben Number ofsubscrlben respondng that they are no longer ellgiHe (This should be o subsd of Bloc* G.) Number of subacrlbers de- emolled or scheduled to be de.emolled as a resdt of noFresponre or response of lneligiHlity from ETC recertification ottempt 0 0 0 0 0 c.) FCC Form 555 November 2014 Sectiol& De-enroll Percentage Using the data entered in &ction 2, complete the chart below to/ind the percentage of xrbsciben de-enrclledfor this ETC. y =(F+K)N =(J+L)O=(N+M)*100) Number of sub,scrlbers that the ETC attempted to recerdfy dlrecdy g through a state admlnlstrator, ETC access to a strte drtsbase, or by USAC (This should qual the nunber reportd in Block E) Number of subscrlbers de enrolled or scheduled to be de enrollcd as a result of nonresponse or inellgibllity Percentage of subscribers de-enrolled or scheduled to be de-enrolled as a result of lnc[glbflity or norreponse 134 16 11.950/o Section 4:PrePaid ETCs All ETCs must complete the apprcpriate check-box; pre-paid ETCs must complete all of Seaion 4. Pre-paid ETCs ganemlly do not assess or collect a monthlyfeefrom their Lifeline subscibers. ETCs that only assess a fee but do not collect such fees are pre-paid ETCs and must complete the chan below. Is the ETC Pre.Paid?Yes [@ No [Gl lf Yes, record the number of subscibers de-enrolledfor non-wage by month in Block Q below. Signature Block Approved by OMB 30604819 P o Month Subscribers De-Enrolled for Non-Usase January 0 February 0 March 0 April 0 May 0 June 0 July 0 August 0 Septanber 0 October 0 November 0 December 0 Total Subscribers 0 By sigring below, I certifr that the company listed above is in conpliance with all federal Lifeline certification procedures. I am an officer of the conpany named above. I am authorized to make this certification for the Study Area Code (SAC) listed above. Jerry M. Allen - Vice PresidentSigned, of Revenues Certified Online Signature of Officer j errv.al len@centurvlink.com Email Address of Officer Thomas Nehls Person Completing This Certification Form Printed Name and Title of Officer 0112812015 Date 720-578-5324 Contact PhoneNumber 3 FCC Form 555 November 2014 Approvod by OMB 30604819 Affiliated ETCs SAC Name 160138 OentrrruT inlr Ilnited Tplnhnnp Cn nf Nerw fcrspw /E'IlA Ijn 170209 Cenfirrvl .ink Ilnifed Telenhone Cn nf Penncwlwcnic FKA t 190254 enfirruT nlr (-antrql Tplenhnna (-n nf Wircinio (EV A Eml 190567 Cenhrrvl nk Ilnited Telenhone-Snrfheesf Inc IFKA F.mhr 210341 CenturvL nk-Embaro Florida Inc. (FKA Embaro) 22035(r Cenhrrvlink Coesfel I Itilities Tnc 230470 Centurvlink Carolina Telenhone and Telesranh Co FKA F 23047t Cenhrrvlink Central Telenhnne Cn -Nnrth CarnlinalF'KA I 2?048s (-anfirnrf inlr ItrIahTal Tna 240506 Centrrrvlink I Inited Telenhone of the Carolinnc-SC fF'K A 250258 Centurvlink Gulf Teleohone ComDanv ),5578*,Cenfirrv[.ink CenfrrnrTel nf Alqhqme fNnrfhem qnrl Snrrfhe 2s978S Centurvlink CenhrrvTel of Alahama fNorthem and Sorrfhe 270423 Cenhrnrl.inlr CentrrruTpl nf Cpnfrql I nrricionq I I a 270424 Centrrrvl .inlr CenfirruTpl nf Snrrfhpqcf T nrriciqno T I C 270427 Centrlrvl.ink CenturvTel of Chatham LLC 270411 Centurvlink CentrrrwTel of Northwest Lorrisiana Inc 270434 Cenhrrv[.ink CenfrrrvTel nf F.wnnoeline I.I .C 270436 Cenhrrv[.ink CenfirrvTel nf Nnrfh Lnrricqnn I.LC 270419 Cenfirrvl-ink CenfirrvTel of Rinoonlzl I [.C 270440 Cenhrrvl -inlr CenfrrnrTel nf F.act T .nrriciqnq I I (- 270442 Cenfirrvl .inlr CenhrruTel nf Snrrthwesf I nrricionq [ [ f- 280458 Centrrrvl.ink CenfirrwTel of North Mississinni Inc 290552 CenturvLink CenturvTel of Adamsville Inc. 290557 CenturvLink CenturvTel of Claibome lnc. 290557 Cenfirrvf .ink IInited Telenhnna-Snrrtheasf Tnc /F'KA Fmhr 290574 Centurvlink CenturvTel of Ooltewah-Colleodale Inc 300630 Cenhrrvl.ink CenfirrvTel nf Ohia Inc 300661 Centurvlink United Teleohone Co. of Ohio FKA Embaro 310671 CenturvLink CenturvTel of Midwest-Michisan Inc. 3 I 0689 CenturvLink CenturvTel of Uoper Michiean Inc. 310702 3 10705 Centurvlink CenturvTel of Northern Michisan Inc. 320747 CenturvTel of Central Indiana Inc. 32080r Cenfurv[.ink CenhrrvTel of Odon Inc 320832 CenturvLink United Teleohone Co. of Indiana (FKA Emba 33084r CenturvLink CenturvTel of the Midwest-Wisconsin (North 3308s7 CenturvLink CenturvTel of the Midwest-Wisconsin (North 330877 CenturvLink CenturvTel of Fairwater-Brandon-Alto LLC 330884 Centurvl,ink CenturvTel of Forestville t.LC 330895 Centurvlink CenturvTel of Wisconsin LLC 330898 Centurvlink CenturvTel of Laresen-Readfi eld LLC 330913 Centurvlink CenturvTel of Monroe Countv LLC 330922 Centurvlink CenturvTel of the Midwest-Wisconsin fNorth 330924 Centurvlink CenturvTe of the Midwest-Kendall LLC 33093 I Centurvlink CenturvTe of Southern Wisconsin [.LC 330934 CenturvLink Centurvl e of the Midwest-Wisconsin (North 3309s0 Centurvl,ink Cenfirw'l e of Northwesf Wisconsin LLC 3309s6 Cenhrrvlink Centrrrv'l e of Northern Wisconsin [.[.C 330959 Centurvlink Centurv]'e of the Midwest-Wisconsin (North FCC Form 555 November 2014 Approved by OMB 3060-08 I 9 Affiliated ETCs SAC Name ji0970 Oenfirruf .inlr CpnfrrruTpl nf thp Midrwesf-\Viccnncin fNnrfh 331 155 CenhrruLink Telenhnne IISA nf Wicconsin I.I .C ?3il59 Centurvlink CentrrvTel of Central Wisconsin [.LC 741057 Cenhrrvl.ink Gallatin River Commrrnications L[.C 751126 Cenhrrvl.ink CentrrrvTel of Chester Inc- 3s1274 Cenhrrv[.ink CentrrrrrTel of Postville Tnc 355 l4t Centurvlink Owest Comoration 361445 Centurvlink CenturvTel of Minnesota Inc. 161L\6 (-entrrruf inlr - Fmhqrn Minnccnfq Inn lFKA Fmhoro\ 755142 Cenhrvlink Owest Comoration 371 595 Centurvl.ink I]nited Telenhone Co- of the West (FKA Emb 71\t 47 Cenh rrvlink Owesf Cornoretion 38s r 44 Centrrrvl.ink Owest Cnrnorafion 395145 Centurvlink Owest Comoration 401142 Cenhrrvl.ink CentrrrvTel of Rrrssellville 401143 Cenhrrvf -ink CenfirnrTel of R rrssellville 401144 (-anhrwTal nf I\rlommnfh Qn#no fanLcnnrrilla 401705 Cenhrrvl.ink CenfirrvTel of Arkansas Tnc- 40171 CenturvTel of Mountain Home Inc. 401720 Cenhrrvlink CentrrnrTel of Redfield Tnc 401727 Cenhrrvlink CentrrrvTel of Sorfh Arkansas Inc 41 1?17 Cenfirrvlink I Inited Telenhone Co-F.astern Kansas fFKA f 411842 Cenfrrrvl-ink Ilnited Telenhone Co - Kansas (F'KA F.mhnrr 4tt9s7 Centurvlink-Embaro Missouri Inc (FKA Embaro) 42ttsl Soectra Communications Grouo LLC dlbla Centurvlink 421957 Cenfrrrvl .inlr-F.mhqrn Missorrri Tnc fFKA F.mhero\ 429784 Cenhrrvl .ink CentrrnrTel of Missorrri I.[.C 42978s Centurvlink CenturvTel of Missouri LLC 429786 Centurvlink CenturvTel of Missouri LLC 429787 Centurvlink CenturvTel of Missouri LLC 442084 Centurvlink United Teleohone Co of Texas Inc. FKA Em 442101 442114 Oentrrrvl .inlr Cenfrel Telenhnne Cn nf Tavqs F'KA Fmhqrr 442117 CenturvLink CenturvTel of Port Aransas Inc. 442140 Centurvlink CenturvTel of San Marcos Inc. 455 l0l Centurvlink Owest Comoration 462185 Centurvlink CenturvTel of Easle Inc. 462187 Centurvlink The El Paso Countv Telenhone Comnanv 462208 Centurvlink CenturvTel of Colorado Inc. 465102 Centurvlink Owest Comoration 472223 CenturvLink CenturvTel of the Gem State (Nevada) 472225 CenturvLink CenturvTel of ldaho Inc. 475103 Cenh rrvl .ink C)wesf Corrrnrefinn 475162 Cenh rrvl ink Owesf Cornorafion 482249 Centurvlink CenturvTel of Montana Inc. 485 104 Centurvlink Owest Comoration 492274 Centrrrvl.ink CenfirnrTel of fhe Sorrthwecf fNew Mexicn\ 495 105 Cenhrrvlink Owest Cornoration 505107 Centurvlink Owest Comoration 5l 1595 CenturvLink United Teleohone Co. of the West (FKA Emh FCC Form 555 November 2014 Approved by OMB 30604819 Affiliated ETCs SAC Name \1))99 (lenfirrvl .inlr CenfirruTpl nf \I/wnmino Tnn 515108 Centrrrvl -ink Orve<f Cnrnorafinn 522400 Cenhrrvlink I Inited Telenhone Co of the Northwest(FKA I 522408 Centurvl.ink CenfirrvTel of Weshinoton Tnc 522410 Centrtrvl ink CentrrrwTel of Cowiche Inc 525161 Cenh rrvlink Owesf Cornoretion 532361 Centurvlink CenturvTel of Oreson Inc.- CenturvTel of Ea 532400 Cenhrrvlink I Inifed Telenhnne Co nf fhe Nor.thrvecf/FKA I sis I 63 Cenhrrvl .ink Ouresf Cnrnnrafinn 552223 Centurvlink CenturvTel of the Gem State (Nevada) 552348 Centurvlink Central Teleohone Co. of Nevada (FKA)