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Home My WebLink About20150130CenturyLink Qwest 475103.pdfApproved byOMB 306048r9 Annual Lifellne Eligible Telecommunications Carrier Certification Form All caniers mtrst conplete all or portions of all sections Form must be submitted to USAC and filed with the Federal Communications Commission IMPORTAI\T: PLEASE RXADI,NSTRUCTIONS FIRST HDeadline: January 31n (Annually) F - ill Does the reporting company have affiIiated ETCs?Yes @l No El Proyide a list of all ETCr that are afiliatedwith the reporting ETC, using page 4 and additional sheets if necessary. Afiliation shall be determind in accordance with Section 3(2) of the Communications Aci That Section defines "afiliate" as "a person that (directly or indirectly) owns or contrpls, is ownd or controlled by, or is under common ownership or control with, another person." 47 U.S.C. S 153(2), See also 47 c.r.n. $ 76.t200. Affiliated ETC's SAC Affiliated ETC's Name - See attached worksheet - For purposes of this filing, an offrcer is an occupant of a position listed in the article of incorponation, articles of formation, or other similar legal document. An officer is a person who occupies a position specified in the corporate by- laws (or partnenhip agreernent), and would tlpically be president, vice president for operations, vice president for finance, conptroller, treasuretr, or a conparable position. If the filer is a sole proprietorship, the owner must sigr the certification. SCgfiOIJi Intffal Certificadon All ETCs must complete this section I certiry 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 program, and that, to the best of my knowledge, the corryany was presented with documentation of each consunrr's household income and/or program$ased 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 authoriznd to make this certification for the Study Area Code listed above. tnitt"t JMA FCC Form 555 November 2014 ID State CenturyLink QC ETCName CenturyLink, lnc. DBA. Marketine or Other Brandins Name(f sanb as ETC naie, l*t "N/A" Donot lede blank) Holdins Comoanv Narne(f sane aF EN n6rt",7is "N/A" Do not leave blank) FCC Form 555 November 2014 Section 2: Annual Recertilication Do not leave empty blocks. If an ETC has nothing to rqort in a block, enter a zero. Recertification Results : K L Number of subccrlbers whose ellglHtity was reviewed by state aduiristrrtor, ETC eccess to eltgiHlity database, or by USAC Nuder of subscribers deemolled or scheduled to be de-emolled as a rerult offindiug of indigiHltty by state eddnistrrtor, ETC access to e[slbtlity database, or USAC 5782 1409 Note: Ifany subscriber was reiewed by an ETC accessing a state database or by a state administrator and subsequently contactd directly by the ETC in an attempt to recertifu eligibility, those subscribers should be listd in Blocks F through J as appropriate and not in Blocks K and L. As a result, all subscribers subject to recertification who were not de-enrolled prior to the recertification attempt mtst be accountedfor in Block F or Block K The tottl of Bloc* F aad Bloc* K should equal the number rqoned in Bloc* E. Approved byOMB 30604819 Certilication: Based on the data entered above, initial the cenification(s) below that apply. Both Certification A and B may apply depending on rte recertification procdures in placefor the SAC reporting on rtisform. If Certification C applies, neirter Cetification A nor B may apply. A.) I certiff that the corpany 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 sigrred 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 offic€r of the conpany named above. I am authoriznd to rnake this certification for the SAC listed above. Inittal AND/ORB.) I certifr that the company listed above has procedures in place to recertify consumer eligibility by relying on: Commrrnitv Action Pnrtnerchin Association of Idaho (CAPAI) Results are provided in the chart above in Blocls K through L. I am an officer of the company named above. I am authorized to make this certification for the SAC listed above. 166x1 JMA OR C.) I certifu that my company did not claim federal low income support for any Lifeline subscribers for the February Form 497 data month for the current 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 A B c D E=(A-B-C-D) Nuder of subacrlbers clalred on February FCC Form 497 of current Form 555 crlendar year (February daU month) Number of lines clelmd on February FCC Form497 of current Form 555 calender year provided to wirdlne reellers Number of cubscriben cleimd on the February FCC Form 497 that were inittallv enrolled ln the current Form 555 calendar yeer (Thcsc subscribcn dU not havc Lifeliac semice pdor to January I ofthe carrcnt 555 calcndar yan) Nuder of subccribers deemolledglgto recertificedon otteryt by elther the ETC, a stete admlnistrator, access to rn ellgibility datrbase, or by USAC Number of subscribers ETC is responslble for recerdfylng for current Form 555 calendar year 6263 0 113 346 5804 F G E=(FC)I J = (E+f) Nuderof subacrlbers ETC contacted dlrectly to recerdfy eligiHltty throrryh attectadon Nuder of subscribcrs respondng to ETC contrc't Nuder of non respond4 subccrlbers Nuder of subscrlben respondlng thet they rre no longer ellglHe (Thls shoultl bc a subsd of Nock G.) Nuder of subscrlben de enrolled or scheduled to be decnrolled rs a r€sult of trorroiponse or retponse of tncltglHlity from ETC recerdficadon iltempt 22 6 16 0 16 FCC Form 555 Novernber 2014 SeCtiAI.t Deenroll Percentage Ilsing the data entered in Section 2, amplete the chart below tofrnd the percantage of subscriben de-enrclledfor this ETC. M =fi'+K)N =(J+L)o = (N +M) * 100) Nuder of subscrlbers thet the ETC attempted to recerd$ direcdyq throqgh a state admlnlstrrtor, ETC access to r state dstabrre, or by USAC (ftis should qual the nunber reportd h Bloch E) Nuder of cubscrlben de enrolled or ccheduled to be de enrolled os a rcult of nonresponse or lnellglHltty Peroentage of subscrlben decnrolled or scheduled to bc de-enrolled as e result of lndlgiblltty or norrespome 5804 1425 24.560/0 Se*tiql.lli PrePaid ETCs All ETCs must complete the apprcpriate chek-box; pre-paid ETCs must complete all of Section 4. Pre-paid ETCs garoally do not assess or collect a nonrt$feefrom their Lifeline subscribers. ETCs rtat only assess afee but do not collect such fees are pre-paid ETCs and must complete the chart below. Is the ETC Pre-Paid? If Yes, record the nwnber ofsubscriben de-enrolledfor non-usage by month in Block Q below. Signature Block Approved byOMB 30604819 Yes @[No E[ P o Month Subscribers De-Enrolled for Non-Usase January 0 February 0 March 0 April 0 Mav 0 June 0 Julv 0 August 0 Sept€mber 0 October 0 November 0 December 0 Total Subscribers 0 By signing below, I certi$ that the company listed above is in coryliance with all fideral 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 PresidentSigred, of Revenues Certified Online Sigrature of Officer i err.v. allen@centurvlink.com Email Address of Officer Thomas Nehls Percon Complaing This Certification Fonn Printed Nune and Title of Officer 01t28t2015 Date 720-578-5324 Contact PhoneNumber 3 FCC Form 555 November 2014 Approved by OMB 3060{819 Affiliated ETCs SAC Narne I 501 38 frantrrnrf inlr IIni+azl Tplnhnnp (-n nf Nerw Tprsav /FKA Fn 170209 Centrrvlink I Inited Telenhone Co of Pennsvlvania FKA I lSO)54 Oenhrnrl .inlr Centrcl Tplcnhnne Cn nf Viroinin t/FKA trmtr 190567 Cenfirrvl.ink I Inited Telenhone-Southeast Inc- fFKA Embr 270341 Centurvlink-F,mharo Florida Inc- ffiKA Emharo) 2203s6 Centrrrvl.ink Coastal I Itilifies Inc- 230470 Cenhrrvlink Carolina Telenhone and Telegranh Co FKA F 230471 (-anfirruf inL Cpnfml Telpnhnne Cn -Nnrth Carnlinqt/EKA I ,?04R5 Ce.nhrrvl ink MehTel Inc. 240506 CentrrruI .inlr I Inited Telenhnne nf thp Carnlinas-SC t/E'KA 250298 Cenhrrvlink Grrlf Telenhone Comnanv 259788 CenhrrvT-ink CentrrnrTel of Alahnmn fNnrthem and Snrrfhp 259789 CcntrrruI nlc CenhrnrTel nf Alahema fNnrthern end Sorrthe 270427 CentrrruI nlr CcnhrruTel nf (lenfrel Lnrriciane I.I .C 270424 OenhrruI.inlr CentrrnrTpl nf Snrrthensf [ -nnisiann [.[ -C 270427 Cenhrrvl.inlr (-enfirnrTcl nf (-hatham I.I.(- 270411 /iarfrrrrf inlr franfira;'Fal nf Nnr4hrrrocf f arriciaaq Tna 270434 Centurvlink CenturvTel of Evanseline LLC 270436 Cenhrvlink CenturvTel of North Louisana LLC )10415 Cenhrru[.ink CenhrruTel of Rinosold [ [ C )70440 Cenhrrvl.ink CentrrrvTel of F.ast Lorrisiana LLC 270442 Cerrhrnr[.ink Ce.ntrrnrTel of Sorrthwest Louisiana [.LC 280458 Cenhrrvl-ink CenfirnrTel nf North Mississinni Inc 290552 Centurvlink CenturvTel of Adamsville lnc. 290557 Centurvlink CenturvTel of Claibome lnc 290567 Ccntnnrl.inlr IInifcd Telenhnne-Snrrtheeet Inc /FKA F-mhr 290574 Cantrrrvl .inlr CenhrrryTpl nf Onhervah-Colleorlale Tnc 300630 Cenfrrrvl.inlr CentrrrvTel nf Ohin Inc 30066r Cenhrrwlinlr Ilnifcd Telenhnne Cn nf Ohio E'KA F.mhern 310671 Centurvlink CenturvTel of Midwest-Michipan Inc. 3 r0689 CenturvLink CenturvTel of Uooer Michiean Inc. 110702 310705 Centurvlink CenturvTel of Northem Michisan Inc. 320747 CenturvTel ofCentral Indiana Inc. 320801 Cpnfirnrl .ink CenfirnrTel nf Orlnn Inc 320832 (-pnhrruT.ink ITnitpd Tplpnhnne Cn nf Indiena lFKA F.mhq 330841 Centurvlink CenturvTel of the Midwest-Wisconsin (North 330857 CenturvLink CenturvTel of the Midwest-Wisconsin (North 330877 CenturvLink CenturvTel of Fairwater-Brandon-Alto LLC 330884 Centurvlink CenturvTel of Forestville LLC 33089s CenturvLink CenturvTel of Wisconsin LLC 330898 Centurvlink CenturvTel of Laresen-Readfield LLC 330913 Cenhrrvlink Cenh-rrvTel of Monroe Countv I-LC 330922 Centlrrvl.inlr (-enhrnrTal nf fhe Mir{rvest-Wiq:nnsin fNnrth 330924 (-enhrruT.inlr CentrrruTel nf the Midrvast-Kendnll LI-C 330931 Cpnfirrvl .inlr CcnfirruTpl nf Snrrthcrn Wiccnnsin I.[.(- 330934 Cenhrrvlink CenhrrvTel of fhe Midwesf-Wisconsin fNorfh 330950 Centurvlink CenturvTel of Northwest Wisconsin LLC 330955 CenturvLink CenturvTel of Northern Wisconsin LLC 330959 Centurvlink CenturvTel of the Midwest-Wisconsin (North FCC Fom 555 November 2014 Approved by OMB 30604819 Affiliated ETCs sAc Name 330970 OpnfirroI inlr (-anfirruTpl nf tha Mirlwect-Wicnnnsin l'Nnr{h 33r 155 Cenfrrrvf .inlr Telenhnnc IISA nf Wiecnnqin f -I .C 331 159 Centrrrvlink CentrrrwTel of Central Wisconsin [.LC 741O57 Cenhrvl.ink Gallatin R iver Commrrnications [.LC }s1126 Cenhrrvl.ink CentrrrwTel of Chester Inc- 3512t4 Cenhrrvlink Ce.nhrnrTel of Postville Inc. 355 l4l Centurvlink Owest Comoration 361445 Centurvlink CenturvTel of Minnesota Inc. 761L56 l-anfrrrof inlr - Fmham fufinnecnlo Inn ttEllA Fmharn\ 36s142 Centr rrvl.ink Owest Cornorafi on 371595 Centrrrvlink I Inited Telenhone Co. of the West (FKA Emt 375143 (acafrrarf inlz f\rrracf lanmnrafina 385 I 44 Centrrrvlink Owest Comorati on 395 1 45 Centrrrvlink Owest Comoration 401142 Centurvlink CenfrrrvTel of Russel lville 401 143 Centrlrvlink CentrrrvTel of Russel lvi lle 401144 OcntrrnrTcl nf Mammnth Snrino Iqnlr<nnwille 401705 Centurvlink CenturvTel of Arkansas Inc. 40171 CenturvTel of Mountain Home Inc. 401720 Centurvl.ink CentrrrvTel of Redfield Inc. 401727 Centrrrvlink CenfirrvTel of Sorfh Arkansas Inc- 411317 Cenhrrvlink Ilnited Telenhone Co-Eastem Kansas (FKA I 411842 (aanfirrof inle I Initprl Talpnhnna (-n - Ilqneac lrE'K A Fmhqn 411957 Centurv[.ink-Emharo Missouri Inc (FK A Embaro'] 42tt5t Soectra Communications Grouo LLC dlbl a Centurvlink 421957 Centrrrvlink-Emharo Missorrri Inc (FKA Emharo) 429784 Centurwlink CenfirrvTel of Missouri LLC 42978s Ccnfirrvl .inlr OenhrrvTel nf Miqcnrri I.I .C 429786 Centrrrv[ -ink CcnhrnrTel nf Missorrri I .I .O 429787 Centurvlink CenturvTel of Missouri LLC 442084 Centurvlink United Teleohone Co of Texas Inc. FKA Eml 442101 442114 Cenfrrrvf.ink Cerrfral Telenhnne Co of Tenae FKA F-mharo 442117 Centurvlink CenturvTel of Port Aransas Inc. 442140 Centurv[,ink CentrrrvTel of San Marcos Inc- 455101 Cenfurvlink Owest Comoration 46218s Centurvlink CenturvTel of Ea-sle Inc- 462187 Centurvlink The El Paso Countv Telenhone Comoanv 462208 CenturvLink CenturvTel of Colorado Inc. 465102 Centurv[,ink Owest Cornoration 472223 Centurvlink CenturvTel of the Gem State (Nevada) 472225 Centurvlink CenturvTel of Idaho Inc 475101 Cenfurvlink Owest Comoration 475152 Cenfu rvl.ink Owest Corrroration 482249 Centurvlink CenturvTel of Montana Inc- 485104 Centurvlink Owest Comoration 49)11A Cenhrrvl-inlr CentrrrvTel nf fhc Snrrthwpct fNerv Mevicn\ 4951 OS Cenfrrrvl -ink f)weet Cornorafion 505107 Centurvlink Owest Comoration 5l 159s Centurvlink United Telenhone Co. of the West (FKA Emb FCC Form 555 November 2014 Approved byOMB 30604819 Affiliated ETCs sAc Nanp 512),59 Cenfirrvl.ink CentrrrrrTel nf W'vomino Inc 515108 CenhrrvLink Owest Cornoraf ion s22400 (aanfrrarf inlz I Initorl 'Talanhnna (an nf fha Nnrfhrrrocf/Ell A I 522408 Centnnrl.inlr OenhrnrTel of Wachinotnn Inc 52241O Centrrrvl.inlr (-entrrrvTcl nf (-nwiche Inc 525161 CenhrruI .inlr Owecf (-nrnnrctirrn 532361 Ccnhrrvl.inlr CcnhrnrTpl nf f)reonn Inn (-entnnrTcl nf F.a s32400 CentrrrvT.ink I Inited Telenhone Co of the Northwesf(FKA I s35t 63 Cenhrrvl.ink Owesf Comoration 552223 Centrrrvl.ink CenturuTel of the Gem State (Nevada) ss2348 Centrrrvl.ink Central Telenhone Co- ofNevarla (FKA)