20180131CenturyLink North Form 555.pdf

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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 31,l. (Annually)
Does the reporting company have affiliated ETCs? Yes Ei] 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 j(2) of the Communications Act. That Section defines "afrtliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common ownership or controlwith, another person." 17 U.S.C. S 153(2). See also 47
c.r.R. $ 76.1200.
Affiliated ETC's SAC lnmtiut"a ETC's Name
- S"" attache{ worksheet -
475162 143005231 A/o rfL-
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certificationformfor each SAC throughwhich it provides Lifeline senice).
2017 lD CenturyLink Qwest Corporation
Recertification Year
N/A
State ETC Name
CENTURYLINK
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do not leave blank)
Holding Company Name
(lf same as ETC name, list "N/A" Do not leave blank)
1,
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the oppropriate check-box. ETCs that do not assess and collect a monthly fee from their Lifeline subscribers are subjecl
to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number ofsubscribers de-enrolled by month in
Section 4. ETCs that only assess afee but do not collect suchfees 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 ofsubscribers de-enrolledfor non-usage by month in Block Q below.
P o
Month Subscribers De-Enrolled for Non-Usage
January 0
Februarv 0
March 0
April 0
May 0
June 0
July 0
August 0
September 0
October 0
November 0
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 ort Alt ETCs must complere this secrion
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; 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.
JMAInitial
2
December
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 JMA
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 monthB. Subscribers de-enrolled prior to recertification attemptsC. Total number of subscribers ETC is responsible for recertifying (A-B)
Recertification 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
E. Name of the data source(s) used to verify consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertify (You may also use this section to report subscriber initiated recertifications).
the number ofLifeline subscribers the ETC contacted to obtain recertification
G. Subscribers who failed to recertify through ETC direct outreach attempt
the number ofLifeline subscribers de-enrolled due to or to the ETC's outreach
3
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
A.0 0 0 0 0 0 3 b 5 7 32 40 93
B 0 0 0 0 0 0 0 0 0 0 1 2 3
C 0 0 0 0 0 0 3 6 5 7 31 38 90
Jan Feb lllar Ap.May Jun Jul Aug Sep Oct Nov Dec Year
Total
D.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
F 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb NIar Ap.May Jun Jul Aug Sep 0ct Nov Dec Year
Total
G.0 0 0 0 0 0 0 0 0 0 0 0 0
0
H. Subscribers who recertified through ETC direct outreach attempt
the number of Lifeline subscribers that recertified ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third parfy administrator, or USAC
the number of Lifeltne subscribers contacted a state administrator third or IJSAC fbr the
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 or to outreach from a state administrator third
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number ofsubscribers that recertified from a state third or USAC
of recertification.
or USAC.
a
Certification:
Recertification Method: Database
I certiff that the company listed above has procedures in place to recertifr 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
I 0 0 0 0 0 0 3 6 5 7 31 38 90
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
K.0 0 0 0 0 0 0 4 2 2 9 10 27
Jan Feb NIar Ap.May Jun Jul Aug Sep Oct Nov Dec Year
Total
L.0 0 0 0 0 0 3 2 3 5 22 28 63
Recertification Method: ETC
I certify that the company listed above has procedures in place to recertifu 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 certify 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.
1n;1;21 JMA
No Subscribers
I certify that my company did not claim federal low income support for any Lifeline subscribers for the current Form 555
datayear.l am an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial
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,
Jerry M. Allen, VP Revenues Jerry M. Allen, VP Revenues
Signature of Officer
Jerry.Allen@centu rylink. com
Email Address of Officer
Pam Hankins
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 25,2018
Date
318-388-9174
Contact Phone Number
M: (G+K)N: (D+F+l)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
recertilication who were de-enrolled
27 90 30.0%
5
Affiliated ETCs
SAC Name
I 601 38 United Telephone Company of New Jersey, Inc
170209 United Telephone Company of Pennsylvania LLC, The
190254 Central Telephone Company of Virginia
190567 United Telephone Southeast, LLC (Virginia)
210341 Embarq Florida, Inc.
2203s6 Coastal Utilities, Inc
230470 Carolina Telephone and Telegraph Company LLC
23041 1 Central Telephone Company (North Carolina)
230485 Mebtel, Inc
240506 United Telephone Company of the Carolinas LLC
250298 Gulf Telephone Company, LLC
259788 CenturyTel of Alabama, LLC (Southern)
259789 CenturyTel of Alabama, LLC (Northem)
210434 CenturyTel of Evangeline, LLC
280458 CenturyTel of North Mississippi, Inc
290552 CenturyTel of Adamsville, Inc
290557 CenturyTel of Claiborne, lnc.
290s67 United Telephone Southeast, LLC (Tennessee)
290574 CenturyTel of Ooltewah-Collegedale, Inc.
300630 CenturyTelof Ohio, Inc
30066 I United Telephone Company of Ohio
31067 I CenturyTelMidwest - Michigan, Inc.
3 1 0689 CenturyTel of Upper Michigan, Inc.
310702 CenturyTel of Michigan, Inc
3 l 0705 CenturyTel of Northern Michigan, Inc.
320747 CenturyTel of Central Indiana, Inc.
320801 CenturyTel of Odon, Inc.
320832 United Telephone Company of Indiana, Inc
33084 I CenturyTel of the Midwest-Wisconsin, LLC (Cencom)
3308s7 CenturyTel of the Midwest-Wisconsin, LLC (Casco)
330877 CenturyTel of Fairwater-Brandon-Alto, LLC
330884 CenturyTel of Forestville, LLC
33089s CenturyTel of Wisconsin, LLC
330898 CenturyTel of Larsen-Readfi eld, LLC
3309 l 3 CenturyTel of Monroe County, LLC
330922 CenturyTel of the Midwest-Wisconsin, LLC (Northwest)
330924 CenturyTel of the Midwest-Kendall, LLC
33093 r CenturyTel of Southern Wisconsin, LLC
330934 CenturyTel of the Midwest-Wisconsin, LLC (Platteville)
330950 CenturyTel of Northwest Wisconsin, LLC
3309s6 CenturyTel of Northern Wisconsin, LLC
330959 CenturyTel of the Midwest-Wisconsin, LLC (Thorp)
330970 CenturyTel of the Midwest-Wisconsin, LLC (Wayside)
331155 Telephone USA of Wisconsin, LLC
331 159 CenturyTel of Central Wisconsin, LLC
341051 Gallatin River Communications, LLC
Affiliated ETCs
SAC Name
351126 CenturyTel of Chester, Inc.
351274 CenturyTel of Postville, Inc.
355 I 4l Qwest Corporation (lowa)
361445 CenturyTel of Minnesota, Inc.
361456 Embarq Minnesota, Inc
365142 Qwest Corporation (Minnesota)
37 1595 United Telephone Company of the West (Nebraska)
375143 Qwest Corporation (Nebraska)
385144 Qwest Corporation (North Dakota)
395145 Qwest Corporation (South Dakota)
401142 CenturyTel of Northwest Arkansas, LLC (Russellville)
401143 CenturyTel of Northwest Arkansas, LLC (Siloam Springs)
401144 CenturyTel of Central Arkansas, LLC
401705 CenturyTel of Arkansas, Inc.
401711 CenturyTel of Mountain Home, Inc.
401720 CenturyTel of Redfield, Inc.
401727 CenturyTel of South Arkansas, Inc.
411317 United Telephone Company of Eastern Kansas & United Telephone Comp
411842 United Telephone Company of Kansas
411957 Embarq Missouri, Inc. (Kansas)
421151 Spectra Communications Group, LLC
421957 Embarq Missouri, Inc
429784 CenturyTel of Missouri, LLC (Central)
429185 CenturyTel of Missouri, LLC (Belle-Herman)
429786 CenturyTel of Missouri, LLC (Southern)
429787 CenturyTel of Missouri, LLC (Southwest)
442084 United Telephone Company of Texas, Inc
442101 CenturyTel of Lake Dallas, Inc.
442114 Central Telephone Company of Texas, Inc.
4421 17 CenturyTel of Port Aransas, Inc.
442140 CenturyTel of San Marcos, Inc.
455101 Qwest Corporation (Arizona)
462185 CenturyTel of Eagle, Inc.
462187 The El Paso County Telephone Company
462208 CenturyTel of Colorado, Inc.
465102 Qwest Corporation (Colorado)
472223 CenturyTel of the Gem State, Inc. (ldaho)
472225 CenturyTel of Idaho, Inc.
475103 Qwest Corporation (Southem Idaho)
475162 Qwest Corporation (Northern Idaho)
482249 CenturyTel of Montana, Inc.
485 l 04 Qwest Corporation (Montana)
492274 CenturyTel of the Southwest, Inc.
495 r 05 Qwest Corporation (New Mexico)
505 1 07 Qwest Corporation (Utah)
511595 United Telephone Company of the West (Wyoming)
Affiliated ETCs
SAC Name
512299 CenturyTel of Wyoming, Inc
5r5r08 Qwest Corporation (Wyoming)
s22400 United Telephone Company of the Northwest (Washington)
522408 CenturyTel of Washington, Inc. & CenturyTel of Inter-lsland, Inc
522410 CenturyTel of Cowiche, Inc.
525161 Qwest Corporation (Washington)
532361 CenturyTel of Eastern Oregon, Inc.
s32361 CenturyTel of Oregon, Inc.
532400 United Telephone Company of the Northwest (Oregon)
535 1 63 Qwest Corporation (Oregon)
552223 CenturyTel of the Gem State, Inc. (Nevada)
5s2348 Central Telephone Company (Nevada)