20160708Custer Telephone Broadband Form 481.pdf

Custertlephone Broadband Services I LC.
Challis Headquarters
P.O. Box 324
1 101 E. Main Ave.
Challis,lD 83226
208-879-4000
Salmon Office
400 Shoup Street
Salmon,lD 83467
208-756-4111
Tol I Free: 1 -866-87 9 -2281
July 1 ,2016
Ms. Jean Jewell
Commission Secretary
ldaho Public Utilities Commission
47 2 W est Washington Street
Boise, ldaho 83720
jean.jewell@puc. idaho.gov bNR-Ttb?t
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RE: 2016 Eligible Telecommunications Carrier (ETC) Annual Reporting
Requirements with the IPUC
Dear Ms. Jewell:
Custer Telephone Broadband Services LLC (l'the Company") hereby
provides copies to the ldaho Public Utilities Commission ("Commission") of the
filing to the Federal Communications Commission ("FCC") and the Universal
Service Administrative Corporation ("USAC') for designation as an Eligible
Telecommunications Carrier, in accordance with 47 U.S.C. 54.313 and 54.422.
Section 54.313 applies to eligible telecommunications carriers ("ETCs") receiving
high cost federal USF support and Section 54.422 applies to ETCs receiving low-
income support. Both sections require the Company to file the annual report with
the FCC, USAC and the Commission. I have also included the signed Affidavit
pursuant to Commission Order 29841.
Company is an Eligible Telecommunications Carrier (ETC) providing Life
Line service and receives universal service low-income support only, therefore
further requests the Commission disregard item 5 of the Affidavit.
lf you have any questions, do not hesitate to contact me directly.
SincerelS,,
t!r^,"r X"7A-^,,*,
Dennis L Thornock
President and General Manager
State of CERTI FICATION BY ELIG I BLE TELECOMM UN ICATIONS CARRI ER
) ss OF COMPLIANCE WITH SERVICE QUALITY AND CUSTOMER
Countyof-)PRoTEcTloN,ABlLlTYToREMAlNFUNcTloNALlN
EMERGENCIES, AND USE OF FEDERAL HIGH-COST SUPPORT.
AFFIDAVIT OF BUSINESS OR CORPORATE OFFICER
The ldaho Public Utilities Commission Order No. 29841requires that Eligible Telecommunications Carriers
certify that it is compliant with applicable service quality standards and consumer protection rules; and
ETCs must demonstrate the ability to remain functional in emergencies. ln addition, the Commission must
file an annual certification with the USAC and the FCC that allfederal high-cost support provided to ETCs
within the State of ldaho will be used only for the provision, maintenance, and upgrading of facilities and
services for which the support is intended. Accordingly, the undersigned states and verifies under oath the
following:
1. I am an officer of Custer Telephone Broadband Services LLC, an eligible telecommunications carrier for
receiving federal universal service support under section 214(e) of the Telecommunications Act of 1996 in
the state of ldaho.
2.1 am familiar with the Company's day-to-day operations in the state of ldaho and with the State's service
quality standards and consumer protection rules as set forth in Commission Order No. 29841,
3. Custer Telephone Broadband Services LLC is complying with applicable service quality standards and
consumer protection rules of the Federal Communications Commission and the ldaho Public Utilities
Commission.
4. I certify to the Commission that the Company is able to remain functional in emergencies as set forth in
Commission Order No. 29841 and in 47 C.F.R. $ 54.201(a)(2).
5. I also certify that all federal universal service support funds received by during
the current calendar year will be used in a manner consistent with section 254(e); that is, for the provision,
maintenance, and upgrading of facilities and services for which the support is intended. The company will
continue to comply for the period of January 1 , 2017, through December 31 ,2017, to be eligible for federal
universal service fund support.
6. This verification and affidavit is provided to be the ldaho Public Utilities Commission to enable the IPUC
to certify to the FCC that federal universal service support received by the eligible carriers in the state will
be used in a manner consistent with Section 254(e) of the Telecommunications Act.
SUBSCRIBED AND SWORN to before me tris\dO day of
Notary Puuic ff
My Commission expires
Date:
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'ry,hg,s.I.$.^^s
Page 1
<010> Study Area Code
<015> Study Area Name Custer Telephone Broadband Servlces LLC
<020> Program Year
<030> Contact Name: Person USAC should contact
with questions about this data Demls L Thornock
<035> Contact Telephone Number:2088?92281 ext-17
Number ot the ldentitied in data line <030>
<039> Contact Email Address:
Email of the person identitied in data line <O3O> dennls@custertel'net
Form Type s4.422
Page 1
?age 2
(1001 Seruice Quality lmprovement Reporting
Data Collection Form
FCC Form 481
OMB Control No. 3050{986/OMB Control No. 3060.0819
Julv 2013
<030> Contad Namr 'P.rcon UsAc rhould contad this data
<035> Contad NuhbEr - Numb€r of identili€d in data line <03O>
<039> cohtad Ehail Addr..s - Email Address of identiti€d in data lin€ <030>
.o<11O> Harvorrr.nmne.vr...ivedit<FTr...rifi.rti6nfronthpFarT Iv.</h.ll
.,rr, X":il:liliJ,tiXfi;"til:i"s'dovouhaveanexistins
5s4'202(a) "s
rv.,l"or O O
lf your answer to Line <111> is yes, please file a progress report, on line
<112> delineatinS the status of your company's existing 5 54.202(a) "5 year
plan" on file with the FCC, as it relates to your provision of voice telephony
seruice.
j112; Attach Five-Year Service Quality lmprovement Plan or, in subsequent years,
yourannualprosressreportfiledpursuantto4Tc.F.R.$54.313(a)(1). lfyourcompanyisa
CETC which only receives frozen support, your progress report is only
required to address voice telephony servlce.
<1 13>
<114>
<115>
<116>
<777>
< 118>
Please select the appropriate responses below (Yes, No. Not Applicable) to confirm
that the attached document(s), on line 112, contains a progress report on its five-year
seruice quality improvement plan pursuant to 554.202(a). The ihformation shall be
submitted at the wire center level or cehsu5 block as appropriate.
Maps detailing progress towards meeting plan targets
Report how much universal service (USF) support was received
How much (USF) was used to improve seruice quality and how support was used to improve seruice quality
How much (USF) was used to improvo seryice cgverag€ and how supporlwas u6sd to improve seruice coverage
How much (USF) was usod to imprcve seryice capacity aod how supportwas used to imprcve seryico capacity
Provide an explanation of network improvement targetr not met
in the prior calendar year.
serulce OutaSe neporting (Volce) FCC Form 481
Coll€ctlon torm OM8 Control No. 3O6O-0986/oMB Cont.ol No. 3060{819
.tuly 2013
Area Cod.
<030> Contad Name - P€rson USAC lhould contad
<035> Contad Number - Number of identified in
Email Addr€ss - Email Address of
<210>
<220>
For the prior calendar year, were there any reportable voice seruice outages?
<30O, Unfumlhd $wie rrq!.rt (wle)
<10> D.t ilon.ttcnDtr (rc|@l
<20> Untumlhd ..de EquEt (hqdb.ndl
<33(b t d.ll oh .n.optr (bE.db.ndl
NamG ofAtbilEd Doauhrm
<010> Study Area Code
<015> StudyArea Name tur.r t l4h@ ar&d &rlc.a M
<020> Program Year
<030> Contact Name - Person USAC should contact re&rdingthis data
<035> Contact Telephone Number - Number of person ldentilted in data line
<039> Contact Email Address - Email Address of person ldentified in data line ture*.*.1.r.r
<400>
<410>
<420>
<430>
<440>
<450>
Select from the drop-down llst to indicate how you would like to report
voice complaints (zero or greaterl for voice telcphony service in th. prior
calendar year for each service area ln whlch you are designated an ETC for
any facilities you own, operate, lcase, or otherwisc utilize.
Complaints per 1000 customers for fixcd volce
Complaints per 1000 customers for mobile voice
select from the drop-down list to indicate how you would like to rcport
end-user customer complaints (zero or trcater) for broadband service in
the prior calendar year for each service area in which you are desitnated
an ETC for any facilities you own, operate, lease, or otherwlse utillze.
Complaints per 1000 customers for fixed broadband
complaints per 1000 customers for mobile broadband
Erddd g.sle.. t&
d!6 &hi.d6h.llAddfit-En.ll Addrc.toltsmn ldsffid ln Su lln.4D &d'ia.ttt.r.Et
<)30> c{ni.d t{.m! . Pmn t sAC rhdld 6t.d r.tildin8 thh d.t M. L tu*r
<035> corilaal Tdaohda l{umbaa - Numbatof EM ldmtmad ln datt lirc <o3o> 20'3?t22'l uL ll
<03$ Cont.d En.ll Mdrs - Emdl Add6 d palsn ldrntm.d in d.u lin. <03{> tuele!.t.r . et
<6d)> ccrtiry @mpll.h@ rci.rdin! .bility to functlon ln mq|lncY ritudion.
<610> t r.cdptlv. dcumcm tor Functlonallty ln Emcrt?n<y Sltuation.
(700! Price Offerings lncluding Volce Rate Data
Data Collection Form
FCC Fom 481
OMB Control No, 3O6O{986/oMB control No. 3050-0819
Julv 2013
<010> Studv Area Code
Area Name B!€&and servlces lLC
<030> Contact Name - Person USAC should contact this data Dennls L rhohock
<035> contact Telephone Number - Number of person identifled in data line <o3o> 2oaa
<039> Contact Email Address - Email Address of oerson identified in data line <030>dennls6.usce!te1 .net
<701> Residential Local S6rvice Charge Effective Date
<702> 5in8le State-wide Residential tocal 5eruice Charge
<703>
Page 9
<nto> a^6r.dNrn.,p.,<^nlr<ar<h^"|i.^nrrdr.r:rdinothi</rl. D,rr,lr L rlurnuck
<015> Contaa T:lephone Number - Numbcr of person rdcntrfied in data hne <o3o> 2086792281 exL'1?
in data lin. <O3O> dennis..usteilel.neE
20t1
St.tc R.tuhtcd
8rcrdb.nd 5crulcc -
Downlo.d Sp..d lro.db.nd scryi.G -Adion T.k.n Wh.n
PaBe 10
Area Code
<030> Contact Name - Person LJSAC thould contact this date
<03S> Contact T identified in data line <03O>2088792201 exc. 1?
Email
<810>Cus.er Telephone Bloa&and s.rvl.es L:C
<811>
Doing Euilne5s As Company or 8,and Oeslgration
Page 1l
4 ?901 9
curEer Tel.phoh€ Bloadband selvlc.! LLc
2011
<030> Contact N.m. - p.r<6h USAC <hould .ont.ct r.rardini this data
<035> Contact Telelhon. Number - Numb.r of o.rson id.ntiri.d in d.t, lin. <030>
d6nnl!6cuat.!tel.ncr
<900> Oocs the filin8 entity offcr tribal land scrvices? (Y/N)
<910> Tribal Land(s) on which ETC Serucs
<920> TribalGovcrnmentEngagemcntObligation
lfyour qompany s.ry.s Tribal lands, plc.s. ialact (Y.s,No, NA) for cach th.s. bor.s
to confirm tho status drscribed of, th! .ttach6d document(s), on line 920,
demonstrates coordlnation with th! Tribel government pursuant to
5 54.313{aX9) ln.lud.s:
<921> NB6ds assossment and deploymgnt planning with a focus on Tribal
community anchor institutions.
Fcaslblllty and sustainabllity plannlng;
Marketing sarvlces in a culturally scnsltivc manncr;
Compliance with Rights of way processes
compliance wlth Land Use permitting requlrements
Compliance with Facilities Siting rules
Compllancc wlth Environmcntal Review proccsses
Compliancc with Cultural Prcsarvation rcview processes
compliance with Trlbal Business and Licensing requirements
<922>
<923>
<924>
<925>
<926>
<977>
<928>
<929>
S€leci
Yes or No or
Not Appllcablo
Page 11
Page 12
<010> Studv Area Codc
Area Name
<020> Prorram Yaar
<030> Contact Namc - Person USAC should contact regarding this data p.m1! & polnock
<035> Contact Telephone Numbcr - Number of person identified in data line <030> 2068?e22.1 .*i r?
<039> Contact Email Add rcss - Ema il Add rcss of person ldentified I n data line <030> d.dhlszcult6rlel . Ect
Voicc scruiccs rate comparability certif ication
Attach detailed deicription for voice seryices rate
comparability compliance
Broadband comparability certification
Attach dctallcd d.scription for broadband
comparability compliance
Nam. of Attach.d Docum.nl
Page 13
<010> Study Area Code
<015> Study Arca Nam.frrt.r T.l.Fhon. Brordbrnd S.rvlc.r Lrc
<020> Program Year
<030> Contact Namc - Person USAC should contact regarding this data ennr" r r"."".x
<035> ContactTrlcphoneNumber-Numbcrofprrsonldentifiedindataline<03D 2o.a7e2r8r.x!.r7
<039> Contact Email Address - Email Address of pcrson idantlficd ln data line <030> aarrocurtcrtcr.nat
<1100> Certiry whcthcr trrrlstrial backhaul options exist MNI
<1130> Please select the appropriab responss (Yes, No, Not Applicable) to conltrm tho
reporting canior ollers broadband s€rvics of at loast 1 Mbps dwnstr€am and 256 kbpg
uFtraam within the 3upported arsa pursuant to S 54.313(9).
Page 13
Page 14
Area Code
<015> Study Area Name &!te! AeleDhone Bloadba.d Servlce! LLC
<020> ProEram Year
<030> Contact Name - Person USAC should contact regardins this data D.nht! L *orhork
<035> Contact TeleDhone Number - Num ber of person identified i n data li ne <030> 2o.s1s22a7 exL .71
<039> Contact Email Addr.ss - Email Address of person identified in data line <030> dehnirocusierrel.ner
<1210> Terms & Conditions of Voice Telephony Lifeline Plans
<!22O> Link to public Wcbsite
4?901rrDl 210. Pdr
Attached
HTTP ntrp,//w."usrerter.her/1mge€/LirdIihe-ms.pdf
"Please check ther€ boxes b.low to confirm that thc attached docum.nt(s), on lln€ 1210,
or the website list.d, on lina 1220, cohtains lhr rcquired lnformation pursuant to
5 54.422(a)(2) annu.l rcporting for ETC5 recclvlnt low-incomr support, carricrs must
annually.eport:
<722lr> lnformation describing thc terms and conditions of any voicc [[|telephony seruice plans offered to Lifeline subscribers,
<1222> Details on the numbcr of minutcs provided as part of thc plan,
<1223> Additional charges for toll calls, and ratcs lor cach such plan.
E
E
Page 14
Pat. 15
cust€! Tslephon. Broa&.nd servlceE Lrc
ideniifi.d in d.te lin. <030>
d.nni!rcur!.rt.l.n.t
and connect America Phase ll support as set forth in 47 CFR S 54.313(b),(c),(d),(e). The information reported on this form and in the documents attached below is accurate.
lncremental Connect America Phase I reporting
<2010> 2nd Year Certification 47 CFR 5 54.313(bX1)(i) - Note that for the July 1
2016 certification, this applies to Round 2 recipients of lncremental
Support
<2011> 3rd Year Ceftification 47 CFR 5 54.313(b)(l)(ii) - Note that for the July 1
2015 certification, this applies to Round 1 recipients of lncremental
Support
<2022> Recipient certifies, representing year two after filing a notice of
acceptance offunding pursuant to 54.312(c), that the locations in
question are not receiving support under the Broadband lnitiatives
Program or the Broadband Technology Opportunities ProBram for
projects that will provide broadband with speeds of at least 4
Mbps/lMbps - 54.313(b}(2xi). Round 2 recipients only.
<2023> The attachment on line 2024 includes a statement ofthe total amount of
capital funding expended in the previous year in meeting Connect
Amerlca Phase I deployment obligations, accompanied by a list of census
blocks indicating where funding was spent. This covers year two -
54.313(bx2xii). Round 2 recipients only.
<2024A> Round 2 Recipient of lncremental support?
<20249> Attach list of census blocks indicating where funding was spent in year
two - 54.313(b)(2)(ii). Round 2 recipients only.
<2025A> Round 1 or Round 2 Recipient of lncremental Support?
<20258> Attach geocoded lnformation for Phase I milestone reports (Round 1 for
year three and Round 2 for year two) - Connect America Fund , WC
Docket 10-90, Report and Order, FCC 13-
<2015> 2016 and future Frozen Support certification 47 CFR $ 54.313(cX4)
ll
Name of Attached Document Listing
Required lnformation
Name of Attached Document Listing
Required lnformation
Pa8. 15
Price Cap Carrier Connect America ICC Support {47 CFR 5 54.313(d)}
<2016> Certification support used to build broadband
Connect America Phase ll Reporting {47 CFR 5 5a.313(e)}
<20174> Connect America Fund Phase ll recipient?
<2O!78> Attach information for Phase ll - 5a.313(eX1) - list ofgeocoded locations
already meeting the 54.309 public interest obligations at the end of
calendar year 2015 and total amount of Phase ll support, if any, the price
cap carrier used for capital expenditures in 2015.
<2018> Attach the number, names, and addresses of community anchor
institutions to which the carrier newly began providing access to
broadband service in the preceding calendar year - 54.313(eX2)(ii)
<2019> Recipient certifies that it bid on category one telecommunications and
lnternet access services in response to all FCC Form 470 postings seeking
broadband service that meets the connectivity targets for the schools and
libraries universal service support program for eligible schools and
libraries located within any area in a census block where the carrier is
receiving Phase ll model-based support, and that such bids were at rates
reasonably comparable to rates charged to eligible schools and libraries in
urban areas for comparable offerings - 5a.313(e)(2Xv)
Name of Attached Document Listing
Required lnformation
Name ofAttached Document Listing
Required lnformation
<2020>
<2027>
Recipient certifies that it offered broadband meeting the requisite public
interest obligations specified in 954.309 to 40% of its supported locations
in the state on December 31, 2017 - 54.313(eX3)
Recipient certifies that it offered broadband meeting the requisite public
interest obligations specified in 554.309 to 60% of its supported locations
in the state on December 31, 2018 - 5a.313(eXa)
<2026> Recipient certifies that it offered broadband meeting the requisite public
interest obligations specified in 554.309 to 80% of its supported locations
in the state on December 31, 2019 - 54.313(eXS)
<2027>Recipient certifies that it offered broadband meeting the requislte public
interest obligations specified in 554.309 to 100% of its supported locations
in the state on December 31, 2020 - 54.313(eX6)
Study Area Code
Study Area Name Custer TeleDhone Broadband Serwices l,l,c
ProSEd Year 2077
Contact Name - Person USAC should .ontact regarding this data Dennis L Thornock
Contact Telephone Number - Number of person ldentified In data line <030>2OAA7922A). ext.17
Cohtact Email Address - Email Address of person identified ih data lihe <030>dennis@custertel . net
Complete the items below to note compliance with five year service quality plan (pursuant to 47 CFR 5 54.202(a)) and, for privately held carriers, ensuring
compliance with the financial reportint requirements set forth in 47 CFR 5 54.313(0(2). I further certify that the information reported on this form and in
the documents attached below is accurate.
(3009)
Progress Report on 5 Year Plan
Carrier certifies to 54.313{f)(1)(iii)
Milestone certification {a7 cFR 5 5a.313(fX1)(i)}(3010A)
(3017)
(3018)
(30108) Please Provide Attachment
(30124) community Anchor lnstitutions (47 CFR 5
s4.313(f)(1)(ii))(30128) Please Provide Attachment
(3013) ls your company a Privately Held ROR Carrier {47 CFR
5 s4.313(fx2))
(3014) lf yes, does your company filc the RUS annual report
Please check thcse boxes to confirm that the
attached PDF, on linc 3017, contains the required
information pursuant to 5 54.313(fX2) compliance
requires:(3015) Electronic copy of their annual RUs reports
(operating Report for Telecommunications
Borrowers)(3016) Document(s) with Salance sheet, lncome statement
and statement of Cash Flows
lf the response is yes on line 3014, attach your
company's RUS annual repon and all required
documentation
lf the response is no on line 3014, is your company
audited?
lf the response is yes on line 3018, please check the
boxes below to confirm your submission on line
3026 pursuant to 5 54.313(f){2), contains:
(3019) Either a copy of their auditcd financial statement; or
(2) a financial report in a format comparable to RUs
operating Report for Telecommunications Borrowers
(3020) Document(s) for Balance Sheet, lncome Statement
and statement of cash Flows
(3021) Management letter and/or audit opinion issued by
the independent certificd public accountant that
performcd thc company's financial audit.
lf the response is no on line 3018, please check the
boxes below to confirm your submission on line
3026 pursuant to 5 54.313(fX2), contains:(3022) Copy of their financial statement which has been
subject to review by an independent certified public
accountant; or 2) a financial r.port in a format
comparable to RUs Operating Report for
Telecommunications Borrowcrs
(3023) Underlying information sub.,ected to a review by an
independent certified public accountant
(3024)Underlying information subjected to an officer
certification,
Document{s} for Balance Sheet, lncome Statement
and Statement of Cash Flows
Attach the worksheet listing required information
(302s)
Name of Attached Document Listing Required
lnformation
Name of Attachcd Document Usting Required'"',i'Si:T O O
(Yes/No) O O
E
E
Name of Attachcd Document Listing Required
lnformation
(Y.s/No)oo
E
E
E
E
E
Name of Attached Document Listing Required
lnformation
E
E
(3026)
Fin.mialDab Summ.ry
(3027) Revenue
(3028) Operating Expenses
(3029) Net lncome
(3030) Telephone Plant ln Seruice(TP15)
(3031) Total Assets
(3032) Total Debt
(3033) Total Equity
{3034) Dividends
PaE. 19
Area Code
<015>Studv Area Name ausr.r f.1.phoi. Bro.dbahd sGlvtc.! LLc
Year
<030>contact Name - Person UsAc should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
Contact Email Address - Email Address of person identified in data line <030> d.nni,o.uE!.!r.r.n.t
4005 Rural Broadband Experiment
Authorized Rural Broadband Experiment (RBE) recipients must address the certilication for public inte.est obligations, provide a list of newlv serued
community anchor institutions, and provide a list of locations where broadband has been deployed.
Public lnterest Oblitations - FCC 14-98 (paragraphs 26-29, 78)
Please address Line 4001 regarding compliance with the Commlssion's public interest obligations. All RBE participants must provide a response to Line 4001
4001. Recipient certifies that it is offering broadband to the identified locations meeting the requisite public
interest obligations consistent with the category for which they were selected, including broadband speed,
latency, usage capacity, and rates that are reasonably comparable to rates for comparable offerings in urban
a rea s?
Community Anchor lnstitutions - FCC 14-98 (paragraph 79)
4003a. RBE participants must provide the number, names, and addresses of community anchor institutions to
whichtheynewlydeployedbroadbandseruiceintheprecedingcalendaryear. onthisline,pleaserespond
(yes - attach new community anchors, no - no new anchors) to indicate whether this list will be provided.
lf yes to 40034, please provide a response for 40038.
4003b. Provide the number, names and addresses Name of Attached Document Listing Required lnformation
of community anchor institutions to which the
recipient newly began providing access to
broadband service in the preceding calendar year.
Broadband Deployment Locations - FCc 14-98 (paragraph 80)
4004a. Attach a list of geocoded locations to
which broadband has been deployed as of the
I un e 1st i mmediately p reced i ng th e Ju ly 1st fili ng Na me of Attached Document Listi ng Required I nformation
deadline for the FcC Form 481.
4004b. Attach evidence demonstrating that the
recipient is meeting the relevant public service
obligations for the identified locations. Materials
must at least detail the pricing, offered broadband Name ofAttached Document Listing Required lnformation
speed and data usage allowanc€s available in the
relevant geographic area.
<010> StudyArea Code { 7 9019
<015> StudvAr.a Nrm.CuaEer Telephone Broadbual Scrvlce€ !&C
<020> Prorram Ycar 2oL1
<030> cont ct Nam. - Person UsAc should cont.ct regerding this data Dcmls t Thonock
<O3S> Cohtrct T.l.6hdn. Numh.r . Numbcr of ocnon idantifi.d in datr linc <O3O> 208879228L erB.l7
<039> Contact Email Addr.ss - Email Addrcss of pcrson idcntificd in deta lin€ <030> dcmlsocusterrel.ret
TO 8E COMPTETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FITING ANNUAL BEPORTING ON ITS OWN BEHAIF:
Certiflcation of Offlcer as to the Accuracy of the Data Reported for the Annual Reportlng for CAF or U Reclpients
crrtlfy th.t I am an officcr ofthc rcportlnS carrlcr; my rcipondblllties indudr cnsu.lnt th3 accurary ofthc annual raportlnt rcqulramcnts for unlyGrsal scMce sppo.t
'cdplcnts; and, to thr best of my knoulcdSc, thc lnformstlon rapo.ted on thl3 form and ln rny tttadrm.nts ls .ccu6tr.
{am.ofR.oortinrcrrri.r. CuStar Telephone Broadbsd Serylces LLC
;irnatur. of I I Officer: CERTTPTED ONLTNE Date 06/29/2016
,rihtad of authorir.d offi.ei. Dsla Thomock
ntle or position ofAuthorized offlc.r: Presldent
lelcphonc number of Authorized Offi crr. 2 088?922 8 1 .xt. 1 7
itudv Area cod€ of ReDortins Carrler: {?9019 Filln8 Due Datc for thls form' 07 / 0L/ 20LG
urder Tltl. 18 of th. Unltcd St.t s Cod., lE U.S.c. 5 1001.
Page 21
! Agent/.carier
Cqllectidn foim .., tllt,.rr:tl
41 9 019<010> Study Area Code
<015> Studv Area Name Custer Telephone Broadband Services LLC
<020> Program Year
<030> Contact Name - Person LJSAC should contact reEardins this data Dennis L Thornock
<035> contactrelephoneNumber-Numberofpersonidentifiedindataline<o3o> 2088792281 ext'17
<039> Contact Email Address - Email Address of person identified in data line <O3O> [e-mail]
TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT 15 FILING ANNUAI. REPORTS ON THE CARRIER'S BEHATF:
TO BE COMPTETEO BY THE AUTHORIZED AGENT:
Certification of Officer to Authorize an Agent to File Annual Reports for CAF or Ll Recipients on Eehalf of Reporting Carrier
certify that (Name of i6 authorized to 6ubmit the informtion reported on behalf of the reporting carrler,
gent; and, to the best of my knowledge, the repods and data provided to the authorized agent is accurate.
.lame of Authorized Asent:
,lam€ of R.oortinr carrier'
iienature of Authorized officer:Dal
rinted name of Authorized Officer:
itle or position of Authorized Officer:
TeleDhone number of Authoriz€d Officer:
Studv Area Code of Reoortins Carrier:Filihe Due Date for this torm:
under Title 18 of the united States Code, 18 U.S.C. 6 1001.
Certification of Agent Authorized to File Annual Reports for CAF or Ll Recipients on Behalf of Reporting Carrier
he data reported herein based on data provided by the reportint carrier; and, to the best of my knowledte, the informatlon reported herein is accurate.
iame of ReoortinE Carrier:
,lame of Authorized Aqent Firm:
e of Authorized AEent or EmDlovee of Afent:Date:
{ame of Authori2ed Arpnt Fmnlov.e
itle or oosition of Authorized Asent or Emolovee of AEent
elephone number of Authorized Aeent or Emplovee of Asent:
itudV Area Code of ReportinE Carrien Filins Due Date for this form
18 ofthe United States Code, 18 U.s.C. 6 1001.
Page 21
Lifeline
What Is The Telephone Assistance Program?
Financial assistance is available in Idaho to help qualified low-income individuals pay
for telephone service. The Idaho Telephone Service Assistance Program (ITSAP) offers
a $2.50 discount on monthly telephone bills. A separate program - the Federal
Communication Commission's Life line program (Lifeline) offers a monthly discount of
$9.25. ITSAP provides a communication "lifeline" to those who might not otherwise be
able to afford telephone service. It also enhances the value of service for everyone by
increasing the number of people who can be reached by telephone. A small surcharge is
applied to every Idaho telephone line each month to reimburse local telephone companies for the cost of state discounts
under ITSAP. The surcharge is waived for customers receiving the ITSAP discount. The Idaho Public Utilities
Commission (IPUC) reviews the surcharge annually and may increase or decrease the surcharge.
Who Is Eligible?
Any residential customer who meets program-based or income-based eligibility criteria. To find out if you are eligible
contact the Eastern Idaho Community Action Partnership.
The assistance provides the following discounts:
Landline:o Idaho Telephone Service Assistance Credit - $2.50o Lifeline Network Access Fee - $6.50o Federal Lifeline Credit - $2.75
How Do I Apply For Assistance?
ln order to receive benefits, you must apply for these programs with the Eastern Idaho Community Action Partnership
(EICAP) office. Website link and local address is listed below. EICAP will work with you and Custer Telephone to
recertify you for the program each year; failure to recertify will terminate your eligibility for program benefits.. Apply at the Eastern Idaho Community Action Partnership office.. If you are eligible, your name and telephone number will be forwarded to Custer Telephone or your local service
provider if different than Custer Telephone.o The monthly discount will begin by your next billing period if your name and number match the telephone
company's records.
Do I Need To Apply Every Year?
Yes. Your eligibility must be renewed each year.
If you have questions regarding ITSAP, please contact Custer Telephone or the Eastern Idaho Community Action
Partnership.
Lifeline is a government assistance program; the service is non-transferable, only eligible consumers may enroll in the
program, and the program is limited to one discount per household.
Eastern Idaho Community Action Partnership
955 Riverfront Drive
Suite A
Salmon, ID 83467
208.756.3999
http:i/www.eicap. ore/
Lifeline Service Terms
Custer Telephone Broadband Services LLC is a quality telecommunications service provider who provides basic and enhanced services
at reasonable rates within its service territory. Basic Residential service is offered at the following rate:
Single Party Residence Service
The following fees apply in addition to the above monthly rates:o Network Access Fee
o Idaho Telephone Service Assistance Program (ITSAP)r Idaho Universal Service Fund (ID USF)o Lemhi County 911 Feer Federal Excise Taxr Federal Universal Service Fund
Single Party Residential Service Total
Federal Lifeline Credit
Network Access Fee Credit
Idaho Telephone Assistance Program Credit
Idaho Telephone Service Assistance Program (ITSAP) Credit
Federal Excise Tax Credit
Federal Universal Service Fund Credit
Single Party Universal Life Line Service Montlrly Rate*
Monthly One-Time
Rates Non-Recurring
Charges
$18.00 $18.00
*Discounted basic service rates and free Toll-Blocking are available to those that qualifu for Universal Life Line Service.
The above rates include the following:r Unlimited Local Callingr Touch Tone Capability
r Access to Operator Serviceso Directory Assistance and Inter-Change Service Providers. Voice Grade Access to the Public Switched Networko Free'Access to 800 and 800-like Toll Free Services
o One Free Directory Listingo Free Access to a Business Office and Free Access to the Idaho Relay Service by Dialing 7l I
Emergency 91 I Service.. .. ... . ... ... .. .. Surcharge for 9 I I services
anffiT*:::::3f:"[
Long Distance is not included.
Long Distance rate is ten cents ($0.10) per minute
Custer Telephone Broadband Services LLC offers basic services to all customers within its service territory.
For additional detail on any of these services, please contact our business office at 208.7 56.411 I or toll-free 866.879 .2281 .
$6.s0
$0.01
$0.12
$1.2s
$0.77
$ 1.16
$27.81
($2.7s)
($6.50)
($2.50)
($o.ol)
($0.03)
($1.16)
$14.86 $18.00