20180202TracFone Wireless Form 555.pdf

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January 31,2018
VIA OVERI[IGHT MAIL
Jean Jewell, Secretary
Idaho Public Utilities Commission
472 W. Washington St.
Boise, ID 83720
Re: TracFone Wireless, Inc. - FCC Form 555 Report
Dear Ms. Jewell:
In accordance with the Federal Communication Commission's Lifeline Reform Order
and 47 CFR 54.416(b) please find enclosed a copy of the FCC Form 555 Report of TracFone
Wireless Inc. ("TracFone"). You may reach me at [phone] if you have any questions.
Sincerely,
Stephen Athanson
Regulatory Counsel
www.tracfone.com I www.net I 0.com I www.straighttalk.com www.safelink.com
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 31x (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 I and additional sheets if necessary. Afiliation 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. " 17 U.S.C. S I 53(2). See also 17
cliR. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
479021 143030103
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 semice).
2017 TracFone Wireless lnc
Recertification Year
SafeLink Wireless
State ETC Name
TracFone Wireless lnc
DBA, Marketing, or Other Branding Name
([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
ID
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 subjecl
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 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 of subscribers de-enrolled for non-usage by month in Block Q below.
P a
Month Subscribers De-Enrolled for Non-Usage
January 6
February 7
March 7
April 5
Mav 5
June 14
July 14
August 12
September 16
October 15
November 26
December 1B
Total Subscribers 145
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 ott Alt ETCs must comptete 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.
JRInitial
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
s4.408.
I am an officer of the company named above. I am authorized to make this certification for the SACs listed above.
Initial JR
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 or federal database.
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 the ETC contacted to obtain
G. Subscribers who failed to recertifu through ETC direct outreach attempt
the number of 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 0 6 20 5 32 39 102
B 0 0 0 0 0 0 0 I 2 0 3 I 15
C.0 0 0 0 0 0 0 5 18 5 29 30 87
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 0
MayJanFebMarApr Jun Jul Aug Sep Oct Nov Dec Year
Total
F 0 0 0 0 0 0 0 5 1B 5 29 30 87
Jan Feb Mar Ap.May Jun Jul Aug sep 0ct Nov Dec Year
Total
G 0 0 0 0 0 0 0 2 9 3 14 15 43
H. Subscribers who recertified through ETC direct outreach attempt
the number of Lileline 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 admin or USAC for the of recertification
J. Name of third party administrator used to verify subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of or to outreach from a state third adm in istrator or USAC.
L. Subscribers who recertified through a state administrator, third party administrator. or USAC's recertification effort
the number ofsubscribers that recertified a fiom a state administrator. third administrator or USAC
Certification
Recertification Method: Database
I certiff 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
Jan Feb Mar Ap.May Jun Jul Aug Sep Oct Nov Dec Year
Total
H.0 0 0 0 0 0 0 3 9 2 15 15 44
MayJanFebMarApr Jun Jul Aug Sep Oct Nov Dec Year
Total
I.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Arg Sep Oct Nov Dec Year
Total
K.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
L.0 0 0 0 0 0 0 0 0 0 0 0 0
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.
Initial JR
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.
Initial
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,
Javier Rosado - Sr. Officer Alternativ,Javier Rosado - Sr. Officer, Alter
Signature of Officer
[e-mail]
Email Address of Officer
Janet Morejon
Person Completing This Certification Form
Printed Name and Title of Oflicer
Jan 3'l ,2018
Date
305-715-6522
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
recertifi cation who were de-enrolled
43 87 49.43%
5
Affiliated ETCs
SAC Name
6