20180119Fremont Telcom Co Form 555.pdf

Blackfoot
ldaho Public Utilities Comrnission
Otlice ol thetsecrelary
JAN I I 2018
January 19,2018 Boise, ldaho
--il!,'t(el^"..Q1"
ldaho Public Utilities Commission
472W. Washington
Boise, lD 83720
Re: WC Docket No. 14-171 and IPUC Case Number GNR-T-18-01
Fremont felcom Co. Respectfully submits the attached certifications pursuant to 47 CFR 554.416 (b)and 54.410 (d)
as required by the Federal Communication Commission's Lifeline Reform Order. The filing has been electronically
filed in accordance ldaho Public Utilities Commission staff guidance.
Sincerely,
Connect to more
Michelle Owens
Regulatory Specialist
Fremont Telcom Co.
1221 N. Russell St.
Missoula, MT 59808
cc: USAC High Cost Low lncome Division
FCC Secretary
1221 North Russet[ St I Mrssouta MT 59808
866-541-5000 | Blackfoot.com
Lifeline Re-Certification - FCC Form 555
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 3l't (Annually)
Does the reporting company have affiliated ETCs? Yes Eil No @
Provide a list of all ETCs that are aJfiliated 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 "ffiliate" 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. S I 53(2). See also 47
c.F.R..{ 76.r200.
Affiliated ETC's SAC Affiliated ETC's Name
ldaho Pu.btic Utilities Commission
Offic_e of the SecretarvBECEIVED
JAN I I 208
Boise,ldaho
7
472222 14300251 5
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommtrnications Carrier (ETC) must provide a certification form for each SAC through which it provides Lifeline service).
2017 ID Fremont Telcom Co
Recertification Year
N/A
State ETC Name
BTC HOLDINGS INC
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do not leave blank)
Holding Company Name
(If same as ETC name, list "N/A" Do not leave blank)
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthlyfeefrom 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 afee 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 @
Ifyes, record the number of subscribers de-enrolled for non-usage by month in Block Q below.
P 0
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
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.
Initial Certificati ol All ETCs must complere 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, 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; andlor
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 certificatiori for the Study Area Code listed
above.
MGInitial
2
Minimum Service Level
I certify that the company listed above is in compliance with the minimum service levels set forth in the 47 CFR Section
54.408.
I am an officer of the company named above. I am authorized to make this certification for the SACs listed above.
Initial MG
Annual Recertification
Do not leave empty blocks. Ifan ETC has nothing to report in a block, enter a zero.
Report the number of Lifeline subscribers due for recertification by month (January-December)
A. Subscribers eligible for recertification by anniversary month
B. Subscribers de-enrolled prior to recertification attempts
C. Total number of subscribers ETC is responsible for recertiffing (A-B)
Recertifi cation Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of subscribers verified access to a state or federal
E. Name of the data source(s) used to verify consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifu (You may also use this section to report subscriber initiated recertifications).
the number of Lifeline subscribers the ETC contacted to obtain recertification of
G. Subscribers who failed to recertiff through ETC direct outreach attempt
the de-enrolled due to to the ETC's outreachor
3
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
A.0 0 0 0 0 0 3 0 2 6 8 5 24
B 0 0 0 0 0 0 0 0 0 0 0
C 0 0 0 0 0 0 3 0 2 b 8 5 24
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
D.0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
F 0 0 0000 0 0 0 0 0 0 0
Jan Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
Feb
G.0 0 0 0 0 0 0 0 0 0 0 0 0
0 0
0
H. Subscribers who recertified through ETC direct outreach attempt
of Lifeline ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the nurnber of Lifeline subscribers contacted a state administrator, third administrator, or USAC for the of recertification.
J. Name of third party administrator used to verify subscriber eligibility:
USAC
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of or to outreach fiom a state third administrator, or USAC.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number of subscribers that recertified a from a state third or USAC
Certification:
Recertification Method: Database
I certiff that the company listed above has procedures in place to recertiff consumer eligibility by relying on a database. I
am an officer of the company named above. I am authorized to make this certification for the SAC(s) listed above.
Initial
4
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
H.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
t.0 0 0 0 0 0 3 0 2 6 B 5 24
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
K.0 0 0 0 0 0 2 0 1 2 5 2 12
Jan Feb Mar Apr Mav Jun Jul Aug Sep Oct Nov Dec Year
Total
L,0 0 0 0 0 0 1 0 1 4 3 3 12
Recertification Method: ETC
I certifu 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 signed certifications from all subscribers attesting
to their continuing eligibility for Lifeline. I am an officer of the company named above. I am authorized to make this
certification for the SAC(s) listed above.
Initial
Recertification Method: Third Party
I certiff that the company listed above has procedures in place to recertify consumer eligibility by relying on an
administrator. I am an officer of the company named above. I am authorized to make this certification for the SAC(s)
listed above.
Initial MG
No Subscribers
I certiff that my company did not claim federal low income support for any Lifeline subscribers for the current Form 555
data year. I am an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial
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,
Marlys Gillen Controller Marlys Gillen Controller
Signature of Officer
mg i llen@blackfoot. com
Email Address of Officer
Michelle Owens
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 17,2018
Date
406-541-5131
Contact Phone Number
x4 = (a+K)N: (D+F+I)O = M/N*100
Total number ofsubscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent ofsubscribers due for
recertifi cation who were de-enrolled
12 24 50.0%
5
Signature Block
Affiliated ETCs
SAC Name
482235 BlackfootTelephone Cooperative lnc.
483308 BlackfootTelephone Cooperative lnc.
6