20180205Boomerang Wireless Form 555.pdf

F\
Ar-lenloucn
x.": "" :",:"*:^.:*, ^:..:
RTCE IVED
?0lB FEB -S At{ 9: 33
if,,'rti0 iuSLtc
I r i :i_iTt ; i; cci,,il,,ilssloN
January 31, 2018
Commission Secretary
ldaho Public Utilities Commission
472W. Washington
Boise, lD 83702
g.L,K-'T- tz-o t
RE: Docket No. Gt*R-f.1t01- FCC Form 555-Annual Lifeline Certification- Filed on behalf of
Boomerang Wireless, LLC dlbla enTouch Wireless
Dear Secretary,
Please contact me if you have any questions regarding this submission at [phone] or
[e-mail]. Your assistance is appreciated.
Sincerely,
0,b
Redman Carter
Regulaton, & Compliance Officer
Boomerang Wireless, LLC dlbla enTouch Wireless
Pursuant to FCC requirements under4T C.F.R. S 54.416, enclosed please find forfiling in the above-
referenced docket a copy of Boomerang Wireless, LLC dlbla enTouch Wireless' FCC Form 555 - Annual
Lifeline Eligible Telecomm unications Carrier Certification.
J
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
Deudline: Jonuary 31st (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 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. S 153(2). See also 47
c.r.R. $ 76.t200.
Affiliated ETC's SAC Affiliated ETC's Name
479022 143036595
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).
2017 lD Boomerang Wireless LLC
Recertification Year
enTouch Wireless
State ETC Name
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do ryJleave blank)
Holding Company Name
(lf same as ETC name, list "N/A" Do not leave blank)
7
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 requiremenls 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 E[
Ifyes, record the number of subscribers de-enrolledfor non-usage by month in Block Q below.
P o
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
IVIay 0
June 0
July 12
August 10
September 4
October I
November 0
December 0
Total Subscribers 27
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 All ETCs must complete this section
I certiff 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.
KALInitial
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 ML
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 veri$ 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 of
G. Subscribers who failed to recertify through ETC direct outreach attempt
the number of Lifeline de-enrolled due to or to the ETC's outreach
Jan Feb Mar Ap.May Jun Jul Aug sep Oct Nov Dec Year
Total
A.0 0 0 0 0 0 21 25 11 1 0 3 61
B 0 0 0 0 0 0 0 0 0 0 0 0 0
C 0 0 0 0 0 0 21 25 11 1 0 3 61
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
D 0 0 0 0 0 0 0 0 00 0 0 0
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
F 0 0 0 0 0 0 21 25 11 1 0 3 61
Apr May Jun Jul Aug sepJanFebMar Oct Nov Dec Year
Total
G.0 0 0 2 2 3 0 0 1 8000
3
H. Subscribers who recertified through ETC direct outreach attempt
the number that recertified ETC'S
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third parfy administrator, or USAC
the number of Lifeline subscribers contacted a state administrator.third or USAC for the of rece(ification.
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 ofsubscribers as a result of or to outreach from a state third admrnistrator 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 administrator, thrrd administrator. or USAC
Certification:
Recertification Method: Database
I certify that the company listed above has procedures in place tc 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 Apr May JunFebMar Jul Aug Sep Oct Nov Dec Year
Total
II 0 0 0 000 2 2 1 0 0 1 6
Jan Feb Mar Ap.May 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 Apt May Jun Jul Aug Sep Oct Nov Dec Year
Total
K.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 00
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 offrcer of the company named above. I am authorized to make this
certification for the SAC(s) listed above.
Initial KAL
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 ciid not ciaim federal low income support for any Litbiine 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,
Kimberley Lehrman, President Kimberley Lehrman, President
Signature of Officer
kleh rman @ readywi reless.com
Email Address of Officer
Summer Algharib
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 29,2018
Date
3197434641
Contact Phone Number
M: (G+K)N = (D+F+l)o = M/t,[*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
8 61 13.11%
5
Affiliated ETCs
SAC Name
6