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HomeMy WebLinkAbout20170120Blackfoot Telephone Cooperative, Inc. Form 555.pdfJanuary 20, 2017 Idaho Public Utilities Commission 472 W. Washington Boise, ID 83720 Lifeline Re~~hi~florf !a!~Cc5fof~5!Pula. MT 59808 866-541-5000 I Blackfoot.com Re: WC Docket No. 14-171 and IPUC Case NumberGNR-T-17-01 Blackfoot Telephone Cooperative, Inc. respectfully submits the attached certifications pursuant to 47 CFR §54.416 (b) and 54.410 (d) as required by the FCC's Lifeline Reform Order. The filing has been mailed in accordance with the Commission's Public Notice DA 14-1731. Sincerely, Michelle Owens Regulatory Specialist Blackfoot Telephone Cooperative, Inc. 1221 N. Russell St. Missoula, MT 59808 cc: FCC Secretary Montana Public Service Commission USAC High Cost & Low Income Division Confederated Salish & Kootenai Tribes r:cc Form 555 November 2016 482235 Annual Lifeline 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: Janua,y JP' (Annually) 143002531 0MB Approval 3060-0819 Study Area Code (SAC) Service Provider Identification Number (SPIN) (An Eligible Teleco111111unicalions Carrier (ETC) 11111s1 provide a cerlijicationformfor eacft SAC through which it provides Lifeline service). 2016 Recertification Year Blackfoot MT State OBA, Marketing, or Other Branding Name (ff same as ETC name, list "NIA" Do not leave blank) Does the reporting company have affiliated ETCs? Blackfoot Telephone Cooperative Inc. ETC Name BTC HOLDINGS INC Holding Company Name (ff same as ETC name, !isl "NIA" Do no1 leave blank) Yes ffi] No fi5) Provide a list of all ETCs that are affiliated with the reporling ETC, using page 4 and additional sheets if necessary. Affiliation shall be determined in accordance wilh Section 3(2) of the Communications Act. That Section defines "affiliate" 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. § 153(2). See also 47 C.F.R. § 76.1200. Affiliated ETC's SAC Affi liated ETC's Name --See attached worksheet -- For purposes of this filing, an officer is an occupant of a position listed in the a1ticle of incorporation, a1t icles 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 fi ler is a sole proprietorship, the owner must sign the certification. Section 1; Initial Certification All ETCs must complete !his section I certify that the company listed above has ce1tification 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 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. I .. 1 mag mha FCC Form 555 Approved by 0M B November 20 14 3060-0819 Sectjon 2: Annual Recertification Do no/ leave emply blocks. If an ETC has nolhing lo repor/ in a block, en/er a zero. A B C D E = (A -B -C -D) Number of subscribers Number of lines Number of subscri bers claimed on the Number of subscribers Number of claimed on February claimed on February February FCC Form 497 that were de-enrolled prior to subscribers ETC is FCC Form 497 of FCC Form 497 of initially enrolled in the current Form recertification attempt responsible for current Form 555 current Form 555 555 calendar year by either the ETC, a recertifying for calendar year calendar year state administrator, current Form 555 provided to wireline (These subscribers did 1101 h11ve Lifeline access to an elig ibility calendar year (February data 111011th) resellers service prior to Ja111w,y I of the curre11t 555 database, or by USAC calendar year.) 200 0 0 40 160 Recertification Results: F G H = (F-G) I J = (H+I) Number of Number of Number of non-Number of subscribers Number of subscribers de- subscribers ETC subscribers responding rcspondi ng that they arc enrolled or scheduled to be contacted directly to responding to ETC subscribe1·s recertify eligibility contact through attestation 0 0 0 K L Number of Number of subscribers whose subscribers de-enrolled or eligibility was scheduled to be de-enrolled as reviewed by state a result of finding of administrator, ineligibility by state ETC access to eligibility administrator, ETC access to database, or by USAC eligibility database, or USAC 160 56 Certification: no longer eligible de-enrolled as a result of non-response or response of (This should he a subset of Block ineligibility from ETC G.) recertification attempt 0 0 Note: If any subscriber was reviewed by an ETC accessing a stale database or by a state administrator and subsequently contacted direclly by /he JDC in an a/tempi to recer/ijj1 eligibility, those subscribers should be /isled in Blocks F through J as appropriate and not in Blocks Kand L. As a resull, all subscribers subject lo recertification who were no/ de-enrolled prior Jo the recerlifica/ion a//empl must be accounted for in Block For Block K. The total of Block F and Block K should equal the number reported in Block E. Based on the data entered above, initial the certification(s) below that apply. Both Certification A and B may apply depending on the recertification procedures in place/or the SAC reporting on this form. 1/Certifica/ion C applies, neither Certification A nor B may apply. A) I certify 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 s igned 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 li sted above has procedures in place to recertify consumer eligibility by relying on: __w.L.J..£::u....~-------------------------· (Lisi database or name of administrator here) 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 ..:..m:...:.a=g __ OR C) I certify that my company did not cla im 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 company named above. I am authorized to make this certification for the SAC listed above. Initial ___ _ 2 FCC form 555 Approved by 0MB November 2014 3060-0819 Sectjon 3: De-enroll Percentage Using the data entered in Sec lion 2, complete !he chart below to find !he percenlage of subscribers de-enrolled/or !his ETC. M = (F+K) N = (J+L) O=((N +M)* 100) 'umber of subscribers that the Number of subscribers Percentage of subscribers ETC attempted to recertify directly de-enrolled or de-enrolled or scheduled to or through a state administrator, scheduled to be de-be de-enrolled as a result of ETC access to a state database, or enrolled as a result of ineligibility or non-response by USAC non-response or (This should equal the 11umber ineligibility reporled i11 Block E) 160 56 35.0% Section 4: ETCs Subject to the Non-Usage Requirements A II ETCs mus/ complete 1he apprqpriate check-box. ETCs that do not assess and collect a monthly.fee from their lifeline subscribers are subj eel lo !he non-usage requirements. ETCs subject lo the non-usage requirements must indicate the number of subscribers de-enrolled by month in Section 4. ETCs Iha/ only assess a fee blll do not col/eel such fees are subject to the non-usage requiremenls and must also indica/e !he number of subscribers de-enrolled by monlh. . Is the ETC subject to the non-usage requirements? Yes [nJ No IE) If yes, record !he number of subscribers de-enrolled/or non-usage by month in Block Q below. p Q Month Subscribers De-Enrolled for Non-Usage January 0 February 0 March 0 April 0 May 0 June 0 July 0 August 0 September 0 October 0 November 0 December 0 Total Subscribers 0 Signature Block By signing below, I certify 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 authorized to make this certification for the Study Area Code (SAC) listed above. Signed, Certified Online Signature of Officer mgi llen@blackfoot.com Email Address of Officer Michelle Owens Person Completing This Certification form Marlys Gillen, Controller Printed Name and Title of Officer 01/10/2017 Date 401-541 -5131 Contact Phone Number 3 FCC Form 555 November 2014 SAC 483308 472222 Affiliated ETCs Name Blackfoot Teleohone Cr,r,npp:itive Inr Fremont Telcom Co. Approved by 0 MB 3060-08 19 4