20180131CenturyLink South 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 RBAD INSTRUCTIONS FIRST
Deodline: January 3ls (Annually)
Does the reporting company have affiliated ETCs? Yes Ei] No @
Provide a list of all ETCs that are affiliatedwith 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 defrnes "ffiliate" as "a person that (directly or indirectly)
ou)ns or controls, is owned or controlled by, or is under common ownership or control with, another person." 47 U.S.C. S I53(2). See also 47
c.r.R. $ 76.t 200.
475103 143005231 $ o..-l-h,
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Catier (ETC) must provide a certification form for each SAC through which it provides Lifeline semice).
2017 ID CenturyLink Qwest Corporation
Recertification Year
N/A
State ETC Name
CENTURYLINK
DBA, Marketing, or Other Branding Name
(l/same as ETC name, list "N/A" Do not leave blank)
Holding Company Name
(lf same as ETC name, list "N/A" Do not lea,re blank)
Affiliated ETC's SAC Ffiit,rt.d ETC's Name
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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
lo the non-usage requiremenis. 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 a
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 olficer 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 ott Atl 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, 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
Minimum Service Level
I,qe{ify that the company listed above is in compliance with the minimum service levels set forth in Ihe 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.
Initiat 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 access to a
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 of Lifeline subscnbers the ETC contacted to obtain recertrfication of
G. Subscribers who failed to recertify through E'l'C direct outreach attempt
the number of 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 22 56 54 122 258 260 772
B.0 0 0 0 0 0 1 0 1 4 11 13 30
C.0 0 0 0 0 0 21 56 53 118 247 247 742
Jan Feb Mar 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 0 000 0 0 1 0 0 0 0 1
Jan Feb Mar Ap.May Jun Jul Aug Sep Oct Nov Dec Year
Total
G.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 party administrator, or USAC
the number of Lifeline subscribers contacted a state administrator, third administrator, or USAC for the
Name of third party administrator used to verifo subscriber eligibility:
USAC
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number ofsubscribers as a result of or to outreach from a state administrator. third administrator, or USAC.
of recertification.
J.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number ofsubscribers that recertified from a state administrator third administrator, or USAC
Certification:
Recertification Method: Database
I certify that the company listed above has procedures in place to recertify 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
Year
Total
Jan Mar Apr May Jun Jul Aug Sep Oct Nov DecFeb
H.0 0 0 0 0 0 1 0 0 0 0 10
Jan Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
Feb Mar
53 118 247 247 741I.0 0 0 0 0 0 21 55
Jan Apr May .f un Jul Aug Sep Oct Nov Dec Year
Total
Feb Mar
16 44 67 64 212K.0 0 0 0 0 0 7 14
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
L.0 0 0 0 0 0 14 41 37 74 180 183 529
Recertification Method: ETC
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 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.
1ni1i21 JMA
Recertification Method: Third Party
I certify that the company Iisted 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.
1p;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
data year. I 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@centurylink. 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
5
M : (G+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 recertifyin g
Percent ofsubscribers due for
recertification who were de-enrolled
212 742 28.57%
Affiliated ETCs
SAC Name
16013 8 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 Err-rbarq Florida, Inc
220356 Coastal Utilities, lnc
230470 Carolina Telephone and Telegraph Company LLC
230471 Central Telephone Company (North Carolina)
23048s 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 (Northern)
270434 CenturyTel of Evangeline, LLC
280458 CenturyTel of North Mississippi, Inc.
290552 CenturyTel of Adamsville, Inc.
290557 CenturyTel of Claiborne, lnc
290567 United Telephone Southeast, LLC (Tennessee)
2905',74 CenturyTel of Ooltewah-Collegedale, Inc
300630 CenturyTel of Ohio, Inc.
30066 r United Telephone Company of Ohio
31067 1 CenturyTel Midwest - Michigan, Inc.
3 r 0689 CenturyTel of Upper Michigan, Inc
310102 CenturyTel of Michigan, Inc.
3 r 0705 CenturyTel of Northern Michigan, Inc
320747 CenturyTel of Central Indiana, Inc.
32080 l CenturyTel of Odon, Inc.
320832 United Telephone Company of Indiana, Inc.
33084 I CenturyTel of the Midwest-Wisconsin, LLC (Cencom)
330857 CenturyTel of the Midwest-Wisconsin, LLC (Casco)
330877 CenturyTel of Fairwater-Brandon-Alto, LLC
330884 CenturyTel of Forestville, LLC
330895 CenturyTel of Wisconsin, LLC
330898 CenturyTel of Larsen-Readfield, LLC
330913 CenturyTel of Monroe County, LLC
330922 CenturyTel of the Midwest-Wisconsin, LLC (Northwest)
330924 CenturyTel of the Midwest-Kendall, LLC
330931 CenturyTel of Southern Wisconsin, LLC
330934 CenturyTel of the Midwest-Wisconsin, LLC (Platteville)
330950 CenturyTel of Northwest Wisconsin, LLC
330956 CenturyTel of Northern Wisconsin, LLC
330959 CenturyTel of the Midwest-Wisconsin, LLC (Thorp)
330970 CenturyTel of the Midwest-Wisconsin, LLC (Wayside)
331r55 Telephone USA of Wisconsin, LLC
33 I 159 CenturyTel of Central Wisconsin, LLC
341057 Gallatin River Communications, LLC
Affiliated ETCs
SAC Name
351126 CenturyTel of Chester, Inc.
351274 CenturyTel of Postville, Inc
355141 Qwest Corporation (lowa)
361445 CenturyTel of Minnesota, Inc
361456 Embarq Minnesota, Inc.
365142 Qwest Corporation (Minnesota)
371595 United Telephone Company of the West (Nebraska)
37 5143 Qwest Corporation (Nebraska)
385144 Qwest Corporation (North Dakota)
39514s 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
4017 tt CenturyTel of Mountain Home, Inc.
401720 CenturyTel of Redfield, lnc.
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)
429785 CenturyTel of Missouri, LLC (Belle-Herman)
429786 CenturyTel of Missouri, LLC (Southern)
429787 CenturyTel of Missouri, LLC (Southwest)
442084 United Telephone Company of Texas, lnc
442101 CenturyTel of Lake Dallas, Inc.
442114 Central Telephone Company of Texas, Inc.
44211',l CenturyTel of Port Aransas, Inc.
442140 CenturyTel of San Marcos, lnc.
455101 Qwest Corporation (Arizona)
462185 CenturyTel of Eagle,lnc
462187 The El Paso County Telephone Company
462208 CenturyTel of Colorado, Inc
46s102 Qwest Corporation (Colorado)
472223 CenturyTel of the Gem State, Inc. (ldaho)
472225 CenturyTel of ldaho, Inc
47s103 Qwest Corporation (Southern ldaho)
475162 Qwest Corporation (Northern ldaho)
482249 CenturyTel of Montana, Inc
48s r 04 Qwest Corporation (Montana)
492274 CenturyTel of the Southwest, Inc.
495 r 05 Qwest Corporation (New Mexico)
50s l 07 Qwest Corporation (Utah)
5u595 United Telephone Company of the West (Wyoming)
Affiliated ETCs
SAC
512299 CenturyTel of Wyoming, Inc
515 r 08 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.
532361 CenturyTel of Oregon, Inc
s32400 United Telephone Company of the Northwest (Oregon)
535 I 63 Qwest Corporation (Oregon)
s52223 CenturyTel of the Gem State, Inc. (Nevada)
552348 Central Telephone Company (Nevada)
lName