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Home My WebLink About20170126Qwest North Form 555.pdfFCC Form 555 November 2016 OMB Approval 3060-0819 1 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: January 31st (Annually) Study Area Code (SAC) Service Provider Identification Number (SPIN) (An Eligible Telecommunications Carrier (ETC) must provide a certification form for each SAC through which it provides Lifeline service). State ETC Name Holding Company Name DBA, Marketing, or Other Branding Name (If same as ETC name, list “N/A” Do not leave blank) (If same as ETC name, list “N/A” Do not leave blank) Does the reporting company have affiliated ETCs? Yes No Provide a list of all ETCs that are affiliated with the reporting ETC, using page 4 and additional sheets if necessary. Affiliation shall be determined in accordance with 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 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 1: Initial Certification 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 program, andthat, to the best of my knowledge, the company was presented with documentation of each consumer’s householdincome 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. Initial Recertification Year 475162 2016 JMA CenturyLink Qwest Corporation CenturyLink QC 143005231 CenturyLink -- See attached worksheet -- ID FCC Form 555 November 2014 Approved by OMB 3060-0819 2 K L Number of subscribers whose eligibility w as review ed 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 of finding of ineligibility by state administrator, ETC access to eligibility database, or USAC Section 2: Annual Recertification 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 of subscribers claimed on February FCC Form 497 of current Form 555 calendar year (February data month) Number of lines claimed on February FCC Form 497 of current Form 555 calendar year provided to wireline resellers Number of subscribers claimed on the February FCC Form 497 that were initially enrolled in the current Form 555 calendar year (These subscribers did not have Lifeline service prior to January 1 of the current 555 calendar year.) Number of subscribers de-enrolled prior 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 recertifying for current Form 555 calendar year Recertification Results: F G H = (F-G) I J = (H+I) Number of subscribers ETC contacted directly to recertify eligibility through attestation Number of subscribers responding to ETC contact Number of non- responding subscribers Number of subscribers 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 recertification attempt 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 recertification attempt must be accounted for in Block F or Block K. The total of Block F and Block K should equal the number reported in Block E. Certification: 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 for the SAC reporting on this form. If Certification 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 itsLifeline subscribers, and that, to the best of my knowledge, the company obtained signed certifications from all subscribers attesting to their continuing eligibility for Lifeline. Results are provided in the chart above in Blocks Fthrough 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 recertify consumer eligibility by relying on:. (List 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 OR C)I certify 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 company named above. I amauthorized to make this certification for the SAC listed above.Initial JMA USAC 0 0 162 0 162 43 0 0 10 141860 FCC Form 555 November 2014 Approved by OMB 3060-0819 3 Section 3: De-enroll Percentage Using the data entered in Section 2, complete the chart below to find the percentage of subscribers de-enrolled for this ETC. M = (F+K)N = (J+L)O = ((N ÷ M) * 100) Number of subscribers that the ETC attempted to recertify directly or through a state administrator, ETC access to a state database, or by USAC (This should equal the number reported in Block E) Number of subscribers 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 Section 4: ETCs Subject to the Non-Usage Requirements All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthly fee from their Lifeline subscribers are subject to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number of subscribers de-enrolled by month in Section 4. ETCs that only assess a fee but do not collect such fees are subject to the non-usage requirements and must also indicate the number of subscribers de-enrolled by month. Is the ETC subject to the non-usage requirements? Yes No If yes, record the number of subscribers de-enrolled for non-usage by month in Block Q below. P Q Month Subscribers De-Enrolled for Non-Usage January February March April May June July August September October November December Total Subscribers 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, Signature of Officer Printed Name and Title of Officer Email Address of Officer Date Person Completing This Certification Form Contact Phone Number 318-388-9174 0 0 Jerry M. Allen, VP of Revenues 0 Pam Hankins 0 0 0 26.54%43 0 0 162 0 0 Certified Online Jerry.Allen@centurylink.com 01/17/2017 0 0 0 FCC Form 555 November 2014 Approved by OMB 3060-0819 4 Affiliated ETCs CenturyLink CenturyTel of Forestville LLC CenturyLink CenturyTel of Fairwater-Brandon-Alto LLC CenturyLink CenturyTel of the Midwest-Wisconsin (Northwest) CenturyLink CenturyTel of the Midwest-Wisconsin (Northwest) CenturyLink United Telephone Co. of Indiana (FKA Embarq) CenturyLink CenturyTel of Odon Inc. CenturyTel of Central Indiana Inc. CenturyLink CenturyTel of Northern Michigan Inc. CenturyLink CenturyTel of Michigan Inc. CenturyLink CenturyTel of Upper Michigan Inc. CenturyLink CenturyTel of the Midwest-Wisconsin (Northwest) CenturyLink CenturyTel of Northern Wisconsin LLC CenturyLink CenturyTel of Southern Wisconsin LLC CenturyLink CenturyTel of the Midwest-Kendall LLC CenturyLink CenturyTel of Northwest Wisconsin LLC CenturyLink CenturyTel of the Midwest-Wisconsin (Northwest) CenturyLink CenturyTel of Laresen-Readfield LLC CenturyLink CenturyTel of Wisconsin LLC CenturyLink CenturyTel of the Midwest-Wisconsin (Northwest) CenturyLink CenturyTel of Monroe County LLC CenturyLink United Telephone Co. of Pennsylvania FKA EmbarqCenturyLink United Telphone Co. of New Jersey (FKA Embarq CenturyLink United Telephone-Southeast Inc. (FKA Embarq) CenturyLink Central Telephone Co. of Virginia (FKA Embarq) CenturyLink CenturyTel of North Louisana LLC CenturyLink-Embarq Florida Inc. (FKA Embarq) CenturyLink CenturyTel of Evangeline LLC CenturyLink Coastal Utilities Inc. CenturyLink CenturyTel of Northwest Louisiana Inc. CenturyLink Carolina Telephone and Telegraph Co FKA Embarq CenturyLink CenturyTel of Chatham LLC CenturyLink Central Telephone Co.-North Carolina(FKA Embarq) CenturyLink MebTel Inc. CenturyLink United Telephone of the Carolinas-SC (FKA Embarq CenturyLink CenturyTel of Ringgold LLC CenturyLink Gulf Telephone Company CenturyLink CenturyTel of Southeast Louisiana LLC CenturyLink CenturyTel of Central Louisiana LLC CenturyLink CenturyTel of Alabama (Northern and Southern) CenturyLink CenturyTel of Alabama (Northern and Southern) CenturyLink CenturyTel of Ohio Inc. CenturyLink CenturyTel of Ooltewah-Collegdale Inc. CenturyLink CenturyTel of Midwest-Michigan Inc. CenturyLink United Telephone Co. of Ohio FKA Embarq CenturyLink CenturyTel of Southwest Louisiana LLC CenturyLink CenturyTel of East Louisiana LLC CenturyLink CenturyTel of Adamsville Inc. CenturyLink CenturyTel of North Mississippi Inc. CenturyLink United Telephone-Southeast Inc. (FKA Embarq) CenturyLink CenturyTel of Claiborne Inc. 330956 330959 330924 330931 330934 330950 330895 330898 330913 330922 190567 330884 190254 170209 330857 160138 330877 230471 320832 230470 330841 220356 320747 210341 320801 310702 310705 310689 280458 290552 290557 290567 290574 300630 300661 310671 270440 270442 270439 230485 240506 270423 270424 259788 259789 270434 270436 270427 270431 250298 FCC Form 555 November 2014 Approved by OMB 3060-0819 4 Affiliated ETCs CenturyLink Qwest Corporation CenturyLink CenturyTel of Colorado Inc. CenturyLink The El Paso County Telephone Company CenturyLink CenturyTel of Eagle Inc. CenturyLink Qwest Corporation CenturyLink CenturyTel of San Marcos Inc. CenturyLink CenturyTel of Port Aransas Inc. CenturyLink Central Telephone Co. of Texas FKA Embarq Century Link CenturyTel of Lake Dallas Inc. CenturyLink United Telephone Co of Texas Inc. FKA Embarq CenturyLink United Telephone Co. of the West (FKA Embarq) CenturyLink Qwest Corporation CenturyLink Qwest Corporation CenturyLink CenturyTel of Montana Inc. CenturyLink Qwest Corporation CenturyLink CenturyTel of the Southwest (New Mexico) CenturyLink CenturyTel of Idaho Inc. CenturyLink CenturyTel of the Gem State (Nevada) CenturyLink Qwest Corporation CenturyLink Qwest Corporation CenturyLink Telephone USA of Wisconsin LLCCenturyLink CenturyTel of the Midwest-Wisconsin (Northwest) CenturyLink Gallatin River Communications LLC CenturyLink CenturyTel of Central Wisconsin LLC CenturyTel of Mountain Home Inc. CenturyLink CenturyTel of Chester Inc. CenturyLink CenturyTel of Arkansas Inc. CenturyLink CenturyTel of Postville Inc. CenturyTel of Central Arkansas LLC CenturyLink Qwest Corporation CenturyTel of Northwest Arkansas LLC CenturyLink CenturyTel of Minnesota Inc. CenturyLink - Embarq Minnesota Inc (FKA Embarq) CenturyLink Qwest Corporation CenturyLink CenturyTel of Redfield Inc. CenturyLink United Telephone Co. of the West (FKA Embarq) CenturyTel of Northwest Arkansas LLC CenturyLink Qwest Corporation CenturyLink Qwest Corporation CenturyLink Qwest Corporation CenturyLink CenturyTel of Missouri LLC CenturyLink CenturyTel of Missouri LLC CenturyLink CenturyTel of Missouri LLC CenturyLink CenturyTel of Missouri LLC CenturyLink United Telephone Co-Eastern Kansas (FKA Embarq) CenturyLink CenturyTel of South Arkansas Inc. CenturyLink-Embarq Missouri Inc (FKA Embarq) CenturyLink United Telephone Co. - Kansas (FKA Embarq) CenturyLink-Embarq Missouri Inc (FKA Embarq) Spectra Communications Group LLC d/b/a CenturyLink 505107 511595 482249 485104 492274 495105 472223 472225 475103 475162 341057 465102 331159 331155 462187 330970 462208 361445 455101 355141 462185 351274 442117 351126 442140 442101 442114 442084 411842 411957 421151 421957 429784 429785 429786 429787 401727 411317 401720 361456 365142 395145 401142 375143 385144 401705 401711 401143 401144 371595 FCC Form 555 November 2014 Approved by OMB 3060-0819 4 Affiliated ETCs CenturyLink Qwest CorporationCenturyLink CenturyTel of Wyoming Inc. CenturyLink CenturyTel of Washington Inc. CenturyLink United Telephone Co of the Northwest(FKA Embarq) CenturyLink CenturyTel of Cowiche Inc. CenturyLink Qwest Corporation CenturyLink CenturyTel of Oregon Inc., CenturyTel of Eastern Oregon Inc. CenturyLink United Telephone Co of the Northwest(FKA Embarq) CenturyLink Qwest Corporation CenturyLink CenturyTel of the Gem State (Nevada) CenturyLink Central Telephone Co. of Nevada (FKA) 522408 522400 515108512299 532400 532361 525161 522410 535163 552223 552348