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Home My WebLink About20150130CenturyLink Qwest 475162 .pdfApproved byOMB 3060-0819 Annual Ufeline Eligible Telecommunications Carrier Certification Form All carriers must corrylete all or portions of all sections Fonn must be submitted to USAC and filed with the Federal Communications Conrmission IMPORTAI\T: PLEASE READ INSTRUCTIONS rIRSt =Deadline: January 31i (Annually) F= ;f -- ! I -.-,, Does the reporting company have afliliated ETCs? Yes @l No Eil Provide a list of all ETCs that are afiliated with the reporting ETC, using page 4 and additional sheets if necessary. Afiiliation shall be determind in accordance with Section 3(2) of the Communications Aa. That Section detines "afiiliate" as "a person that (directly or indirectly) owns or conttols, is ownd or controlled by, or is under common ownerchip or contrul with, dtather person." 47 U.S.C. 0 I5i@. See also 47 c.r.n. $ 76.1200. 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 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 partnenhip agreement), and would tlpically be president, vice president for operations, vice president for finance, corrptroller, treasure,r, or a comparable position. If the filer is a sole proprietorship, the owner must sign the certification. Section l: Inidal Certillcaffon All ETCs must complete this section I certiff that the conpany listed aborre has certification procedures in place to: A) Review income and program$ased eligibility docrunentation pnor to enrolling a consuurcr in the Lifeline prograng and that, to the best of my knowledge, the coryany was presented with documentation of each consurrcr's household incorne and/or program$ased eligibilityprior to his or her enrollment in Lifeline; and/or B) Confirm conswner 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 authorizd to make this certification for the Study Area Code listed above. tntuat JMA FCC Form 555 November 2014 475162 ID CenturyLink Qwest Corporation State CenturyLink QC ETCName CenturyLink, lnc. DBA. Marketins or Other Brandins Name (If sanre as ETC naie, tist "N/A" Do not le;'e blotk) Holdine Comoanv Name(f same ai Erc nine,Tist "N/A" Do not leave blank) FCC Form 555 November 2014 SefliOl2 Annual Recertification Do not leave empty blocks. If an ETC has nothing to rqort in a bloch enter a zero Recertilication Results: K L Nuderof subccrlbers whose eltgiHltty wes reviered by state adddstreton ETC accesc to etigiHlity databasg or by USAC Nuder of subccrlbers deenrolled or schcduled to be dscmolled as e result of ftndng of tneligltfllty by stete eddnlstretor, ETC eccess to eltglbllity drtebasg or USAC 598 158 Notat If any subsciber was reviewed by an ETC access@ a statc d.atabase or by a state administrator and subsequently contactd directly by the ETC in an attempt to recertify eligibility, tlose 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 reertification who were nol de-enrolld pior to the recertification attempt rrust be accountedfor in Block F or Block K. The tobl of Bloch F and Bloch K should qwl the number reponed in Block E Approved byOMB 30604819 Certilicotion: Basd on the data entered above, initial the certification(s) below that apply. Both Certification A and B nuy apply depending on the recertification procdures in place for the SAC reporting on rtis form. If Cenification C applies, neirter Cenification A nor B may apply. A.) I certiff 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 siped certifications from all subscribers attesting to their continuing eligibility for Lifeline. Results are provided in the chart above in Blocls F through J. I am an officer of the coryany named above. I am authorized to make this certification for the SAC listed above. Initial JMA AI\D/OR B.) I certifr that the conpany listed above has procedures in place to recertiS consumer eligibility by relying on: CommunitvActionPefinershinAssocietionofldaho(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. 1ni6s1 JMA OR C.) I certi$ that my company did not claim federal low income support for any Lifeline subscribers for the February Form 497 data month for the curent Form 555 calendar year. I am an offic€r ofthe 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 rubscrlbers clalred on February FCC Form497 of current Form 555 calendar year (February dau aonthl Nuder of llnec clalmd on February FCC Form497 of current Form 555 calendar year provided to wirdine resellers Number of subscrlben clalmed on the February FCC Form497 ttrtwere tntdallv emolled in the current Form 555 calendar year (Thcsc snbscribcn did tot havc Lilcllnc scllcc piar to lanuary I olthc curnnt 555 caladar ycar.) Nuder of subscribers de.emolled pg!99 to recertificefion rttcryt by either the ETG a shte rdmlnlitrrtor, acceis to an eliglbtllty drtrbase, or by USAC Number of suhcrlben ETC is rerponrible for recerdfylng for current Form 555 calendar yeer 657 0 13 37 607 F G H=Ga)I J = (E+r) Number of subscriben ETC contacded directly to recerdfy eltgtttlllty throrryh attectadon Nuderof cubscribcrs reepondry to ETC contrct Nuderof nop respond4 subEcrlben Nuder of rubccrlbers respondng that they ere no longer dtgiHe (Thls shoakl bc a subsct of Btoch G.) Nuder of subscrlben de enrolled or scheduled to bc deerolled rs a rcsult of norrespoille or response of lrc[giH[ty from ETC recerdfcedon attempt 9 5 4 0 4 FCC Form 555 November 2014 Sectial.3r De-enroll Percentage Using the data entered in kction 2 , complete the chart below to fmd the percentage of subsciben de-enrclled for this ETC. 14 =@+K)N = (J+L)O=(N+M)* 100) Number of subccrlbers thrt the ETC attempted to recerti$ direcdy gg throqh a stl@ admlnistrator, ETC actesr to a stete detabesg or by USAC (Ihis slouU qual the nunber reportdh BbckE) Nuder of subscrlben de enrolled or scheduled to be de- enrolled as r result of nonrerponse or lncltglHlity Pcrcentage of subscrlbers deenrolled or scheduled to be de.emolled as a result of lneltglbillty or non-respome 607 162 26.690/o Ssctlqli PrePaid ETCs All ETCs must complete the apprcpriate check-box; prc-paid ETC,s must complete all of Section 4. Pre-paid ETCs ganoallydo 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 chart below. Is the ETC Pre'Paid? Yes @[ No lG[ If Yes, read the number of subsriben de-enrolledfor non-usage by month in Block Q below. P o 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 Decernber 0 Total Subscribers 0 Signature Block Approved by OMB 30604E19 By sigring below, I certiS that the company listed above is in coryliance with all federal Lifeline certification procedures. I am an officer of the conpany named above. I am authorizrd to make this certification for the Study Area Code (SAC) listed above. Jerry M. Allen - Vice PresidentSigrred, of Revenues Certified Online Signature of Officer j errv.allen@centurvlink.com Email Address of Officer Thomas Nehls Person C-ompleting This Certification Form Printed Name and Title of Officer 0112812015 Date 720-578-5324 Contact Phone Number 3 FCC Form 555 November 2014 Approved by OMB 30604819 Affiated ETCs SAC Name r60138 Centurvl.ink Ilnited Telnhone Co of New -Iersev (FKA En 170209 franfirnrf inlz I Initar{ 'I'alanhnna (-n nf Danncvlvonia FI( A I 190254 CenfrrruI .inlr Cpnfrql Tplpnhnne (-n nf Viroinia lFKA Fml r90557 Centrrrvlink I Inited Telenhone-Sorfheast Inc- (FKA F.mhr 210341 Cenhrrvl .inlr-Fmhqrn E'lnridq Tne /E'KA Fmharn\ 220356 Centrrrvlink Coastal I Itilities Inc 230470 Centrrrvl.ink Carolina Telenhone and Telemanh Co FKA F 230471 Centurvlink Central Teleohone Co.-North CarolinafFKA I 2104R5 Centrrrvlink MehTel lnc 240506 CenhrrvT.inlr I Irritpd Tplenhnnp nf fhp Cnrnlinqc-SC /F'KA 2s0298 (-cntrrnrl .inlr Grrlf Tplpnhnne Onmnqnw 2597R*franfirnrf inlr /ranfrrnrTal nf Alolrama l'Nnr{ham anrl Qmrfha ).\91*9 (-anfirnrl inlz (-anhrarTal nf A lalrqma l'Nn#ham anrl Qnrrfhp 270423 Cenhrrvf -ink CenhrnrTel nf Cenfrql I-nrrieiena [.[.C 270424 Cenhrrv[.ink CentrrnrTel nf Snrthelst Lorriciana I.f .C 270427 Cenhrrvl .ink CenhrnrTel nf Chafhern I .[ .C 270431 1\anfrrnrf inlz /aanttrarTal nf \Tnrflrrrraot T 270434 Centurvlink CenturvTel of Evanseline LLC 270436 Centurvlink CenturvTel of North Louisana LLC 270439 Cenhrrv[.ink CenhrrvTel of Rinooolrl LLC 270440 (apnrhrruf inL l^anhrnrTal nf Eact f nrriciora T f /- 270442 Centurvlink CenturvTel of Southwest Louisiana LLC 280458 CenfrrrvT.ink CenfirnrTel nf Nnrfh Micciccinni Inc 290ss2 Centrrrvlink CenfirnrTel of Adamsville Inc 290557 Centurvlink CenturvTel of Claibome Inc. 290s67 Cenhrnrl.ink I Inifed Telenhone-Snnfheact Inc fFKA F.mhr 290574 Cenhrrvl -ink CenhrruTel nf (.)nheurah-(-nlleodale Inc 300630 Cenfrrnrl.ink CenhrnrTel nf Ohin Inc 300661 Cenhrrvlink I Inifed Telenhone Cn nf Ohio FKA Emharn 310671 Centurvlink CenturvTel of Midwest-Michisan Inc. 310689 Centurvlink CenturvTel of Uooer Michisan Inc. 310702 3 l 0705 Centurvlink CenturvTel of Northern Michisan Inc. 320747 CenturvTel of Central Indiana Inc. 320801 Oenfirrvl-ink (-errtrrrvTel nf f)dnn Inn 320832 Cenhrrvl .inlr Ilnitpd Telenhnne Ca nf Indiana lEKA F.mha 330841 CenturvLink CenturvTel of the Midwest-Wisconsin (North 330857 CenturvLink CenturvTel of the Midwest-Wisconsin fNorth 330877 Centurvlink CenturvTel of Fairwater-Brandon-Alto LLC 330884 Cenhrrvlink CenhrnrTet nf Enresfville [-I.C 330895 Centurvlink CenturvTel of Wisconsin LLC 330898 CenturvLink CenturvTel of Laresen-Readfield LLC 330913 Centurvlink CenturvTel of Monroe Countv LLC 330922 Cenhrnrl .inlr CenfrrruTpl nf fha Mirlwpsf-ll/icnnncin fNnrih 330924 Cenhrrvlink CenturvTel of the Midwest-Kendall LLC 33093 l Cenhrrv[-ink CentrrnrTel nf Snrrthern Wicnnnqin I.[.C 330934 Centrrrvlink CenhrrvTel of the Midwest-Wisconsin (North 330950 Cenfirrvl.inlr (-cnhrruTpl nf Nnrfhwpcf \I/icnnncin I.I .C 330955 Cenhrrvl-ink CanhrrvTcl nf Nnrthprn \I/icnnncin I.[.C 330959 Cenhrrvl.inlr CenhrnrTpl nf thc Midwest-\I/is.nnsin fNnrfh FCC Form 555 November 2014 Afliliated ETCs Approvod by OMB 30604819 SAC Name ??0970 (rpnhrruf inL CpnhrruTal nf thp Mirlrracf-Wis.cnnqin fNnrth 33r 155 Cenhrrnrf-inlr Telenhnne IISA nf Wiseonsin [.LC ??'t 159 CpnfirruT inlr CenhrruTpl nf (-pnfrql \l/icnnncin T.I-C 341057 Cenfirrvl.ink Gallafin R iver Communications L[.C 151125 Cenhrrvlink CenhrrvTel of Chester Inc- 351274 Centurvlink CenhrrvTel of Postville Inc. 3ssl4l Cenhrrvlink Owest Comorafi on 361445 Centrrrvl.ink CenhrrwTel of Minnesota Inc. 161L56 (-pnhrruf inL - Fmhqrn Minnpcnlq Inn IE'KA F.mhara) 365142 Centlrnrl .inlr llurecf Cnrnnratinn 371595 Cenhrrul-inlr ITnifed Telenhnnc On nf the Wect /F'KA F-mh 375143 fienfrrnrf inL f)rwacf (anmrofinn 385144 (1anft rnrf inlz f'hwecf (lnmnrafian 395145 Cenhrrvl.inlc Owesf Cnrrorefinn 401142 Centurvlink CenturvTel of Russellville 401143 Centurvlink CenturvTel of Russellville 40114[CenhrrvTel nf Mammoth Snrino fncksonville 401705 Centurvlink CenturvTel of Arkansas Inc- 40t7tt CenhrnrTel nf Mnrrntqin Ifnme Inc 401720 (lanfrrnrf inL laonfrrar'Tcl af Porlfiali fnn 401727 franfrrxrf ialu (lcafirarTcl nf Qnrrfh A droncac fnn 411311 Cenhrrvl .inlr t Tnife.l Telenhnne (ln-F.nefern Kanses fFK A F 411842 Oenfirnrl .inlr I Tnifcd Tclenhnne (-n - Kanens (E'KA Emharr 4tl9s7 Centurvlink-Embaro Missouri Inc (FKA Embaro) 421151 Soectra Communications GrouD LLC dlbl aCenturvlink 421957 Cenhrrwl .ink-Fmharn Miscnrri Inc fE'KA Frnharn\ 429784 Cenhrnrl-intr CcnfirnrTel nf Miccarrri [.[-(- 42978s flenhrrvl .ink CentlrnrTel nf Miccnuri I.f .C 429786 Cenhrrwl -ink CentrrnrTel af Miscnrri I .I -C 42978',7 Cenhrrvl.ink Ce.ntrrrvTel of Miesnrrri I -I .C 442084 Centurvlink United Teleohone Co of Texas Inc. FKA Eml 442101 442114 Centrrrvlink Central Telenhone Co. of Texas FKA F.mharo 442117 Centurvlink CenturvTel of Port Aransas Inc. 442140 Centurvlink CenturvTel of San Marcos Inc. 455101 Centurvlink Owest Comoration 46218s Centurvlink CenturvTel of Easle Inc. 462t87 Centurvlink The El Paso Countv Teleohone Comoanv 462208 CenturvLink CenturvTel of Colorado Inc. 465102 Centrrrvl -inlr Orvesf Cornnrafinn 472223 Centurvlink CenturvTel of the Gem State (Nevada) 47222s Centurvlink CenturvTel of Idaho Inc. 475'.103 lcnfrrrwl -inlr f)wasf (-nrrrnretinn 475162 Centurvlink Owest Comorati on 482249 CenturvLink CenturvTel of Montana Inc- 485104 Centurvlink Owest Comoration ns).)1a Centrrrwl.inlr (-crrhrnrTel nf fhe Snrrthwesf fNe.ur Mpvico\ 49510s Centurvlink Owest Comoration 505107 Centurvlink Owest Comoration 5l 1595 Centurvlink United Teleohone Co. of the West (FKA Emb FCC Form 555 November 2014 Approved by OMB 30604819 Affiliated ETCs SAC Nane sl2299 (lanfrrarT ialz franfrrarTal nf \l/rrnmino fnn sr5108 f'anfirnrf inL f\uacf (lnmnrntinn s22400 Centrrrvl .ink I Tnited Telpnhnne Cn nf fhe NnrfhrvecflE'KA 522408 Centrrrvl inlr flpntrrruTel nf Washinotnn Inc 52241O (-pnfirruI inlr (aenfirruTcl nf Cnwinhc Inn 525161 Centrrrvl.ink Owesl Comoraf ion 532361 Cenhrrvlink CenhrruTel of Oreson Inc-- CenhrnrTel of Ea s32400 Centurvlink United Teleohone Co of the Northwest(FKA l 515 I 5?Centrrrvlink Owest Cornorati on 552227 CcnfirruI .ink OenhrruTel nf fhp Gem Sfefe fNerrede\ 552348 Cenh,rrvlink Cenftal Telenhone Co- of Nevada ffiKA)