20160125Albion Telephone Company ETC Form 555.pdf

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p 208-673-5335 I f 208-673-6200 I e [e-mail] I a 225 W. North St. Albion, lD 83311
January 27,20L6
Grace Seamons
ldaho Public Utilities Commission
PO Box 83720
Boise, lD 83720-0074
Dear Ms. Seamons:
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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.
Sincgrgly, 4
,ffiru*
Rich Redman
Vice President
FCC Form 555
November 2014
Approved by OMB
3060-0819
Annual Ufeline 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 (Annually)
472213
Study Area Code (SAC)
(An Eligible Telecomrmtnications Canier @TC) must provide a certificationfonnfor each SAC throughwhich it provides Lifeline service).
lD Albion Telephone Company lnc.
State
ATC Communications
ETC Name
N/A
DBA. Marketins or Other BrandinsName(f sanie as ETC naie, list "N/A" Do not lefre blank)
Holdins Comoanv Name(f same ai tfC nane,Tist "N/A" Do not leave blank)
Does the reporting company have affiliated ETCs? Yes @ No Gl
Provide a list of all ETCs that are afiiliated with the reporting ETC, using page 4 and additional sheets tf necessary. Affiliation shall be
determined in accordance with Section 3(2) of the Commwications Act. That Section de/ines "afliliate" as "a person that (directly or indirectly)
ov'ns 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.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 sign the certification.
Section l: Initial Certilication 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 prograrn, 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; 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 authorized to make this certification for the Study Area Code listed
above.
Initiat RR
Do not leave empty blocks. If an ETC has nothing to report in a block, enter a zero.
A B C D E=(A_B-C-D)
Number ofsubscribers
clainrcd on February
FCC Form497 of
current Form 555
calendar year
(FebraW data month\
Number of lines
claintd 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
!4!!!g!!y enrolled in the current Form
555 calendar year
(These subscriben did rut have Lileline
semice piorto January I otthe currcnt 555
calendar year)
Number ofsubscribers
de-enrolled glgl to
recertification attempt
by either the ETC, a
state administrator,
access to an eligibility
database, or by USAC
Number of
subscribers ETC is
responsible for
recertiffing for
current Form 555
calendar year
75 0 20 0 55
FCC Form 555
November 2014
SeqtiAl.Zi Annual Recertification
Recertification Results:
K L
Number of
subscriben 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 offinding of
ineligibility by state
administrator, ETC access to
eligibility database, or USAC
75 0
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 subscribers should be listed 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 recerti/ication
attempt musl be accountedfor in Block F or Block K.
The total of Block 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
3060-0819
Certification:
Based on the data entered above, initial the certi/ication(s) below lhat apply. Both CertiJication A and B may apply depending on the recerti/ication
procedures in place for the SAC reporting on this form. If Certifcation C applies, neither Certification 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 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 company named above. I am authorized to make this certification for the SAC listed
above.
Initial
AND/OR
B.) I certify that the company listed above has procedures in place to recertiff consumer eligibility by relying on:
Idqhn t ifplinc Admin T)ant nf IJ,Q'\tr/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.
Initial RR
OR
C.) I certifr that my company did not claim federal low income
Form 497 data month for the curent Form 555 calendar year.
authorized to make this certification for the SAC listed above.
Initial
F G 11= (F_G)I s= 1s+r)
Number of
subscribers ETC
contacted directly to
rccerti$ eligibility
through rttestation
Number of
subscriberc
responding to ETC
contact
Number ofnon-
responding
subscribers
Number ofsubscribers
responding that they are
no longer eligible
(This should be a subset of Block
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
SeCliqJ.i De-enroll Percentage
Using the data entered in Section 2, complete lhe chart below to/ind the percentage ofsubsuibers de-enrolledfor this ETC.
M = (F+K)N = (J+L)o=((N=M)*100)
Number ofsubscribers that the
ETC attempted to recerti$ directly
q through a state administrator,
ETC access to a stste database, or
by USAC
(This should equal the namber
reported in Bloc* E)
Number of
subscriberc 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
75 0 0.00/o
SsCJiqli PrePaid ETCs
All ETCs must complete the apprcpriate check-box; pre-paid ETCs must complete all of Section 4. Pre-paid ETCs generally do not assess or collect a
nonthlyfee from their Lifeline subscribers. ETCs that only assess a fee but do not collect such fees are pre-paid ETCs and must complete lhe
chart below.
Is the ETC Pre-Paid?Yes ltil No [Gil
If Yes, record the number of subscribers de-enrolledfor non-usage by month in Block Q below.
Signature Block
Approved by OMB
3060-0819
P o
Month Subscribers De-Enrolled for Non-Usase
Januarv 0
February 0
March 0
April 0
Mav 0
June 0
Julv 0
August 0
September 0
October 0
November 0
December 0
Total Subscribers 0
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 authorizad to make this certification for the
Study Area Code (SAC) listed above.
Rich Redman
Sigrred,
Certified Online
Signature ofOfficer
[e-mail]
Email Address of Officer
Julie Laumb
Person Completing This Certification Form
Printed Name and Title of Officer
01t21t2016
Date
208-673-5335
Contact Phone Number