20180731Filer Mutual Form 555.pdf

RECEIVED
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July 26, 2018
Ms. Diane Hanian
Commission Secretary
Public Utilities Commission of ldaho
472W Washington
Boise, lD 83702
RE: FGC Docket14-171: Annual Lifeline Certification for Filer MutualTelephone
Company, lnc. in ldaho
Dear Ms, Hanian,
Filer Mutual Telephone Company, lnc. ("the Company" or "File/') is submitting the
attached informational filing to the Public Utilities Commission of ldaho ("Commission")
pursuant to FCC Docket 14-171 in the Matter of Federal-State Joint Board on Universal
Service Lifeline and Link Up Reform and Modernization. This filing contains a copy of
the FCC Form 555 submitted to USAC on January 30,2018 and a copy to the FCC on
July 26,2018.
Please do not hesitate to call me if you have any questions
Sincerely,
Justin Rector
Accountant
Enclosures
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Annual Lifeline Eligible Telecommunications Carrier Certification Form All caniers 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't (Annually)
Does the reporting company have affiliated ETCs? Yes E[ 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 "ffiliate" as "a person that (directly or indirectly)
ov)ns 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
cr.R. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
1
472220 143002513
Study Area Code (SAC) Service Provider ldentification Number (SPfN)
(An Eligible Telecommunications Carrier (ETC) must provide a certification form for each SAC through which it provides Lifeline service).
2017 ID Filer Mutual Telephone Company
Recertification Year
N/A
State ETC Name
DBA, Marketing, or Other Branding Name
(If same as ETC name, list "N/A" Do nol leave blank)
Holding Company Name
(lf 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 monthlyfee from their Lifeline subscribers are subject
to the non-usage requirements. ETCs subjecl 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 E[
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
February 0
March 0
April 0
Mav 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 ort Atl ETCs nust 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.
RKInitial
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 RK
Annual Recertification
Do not leave empty blocks. Ifan ETC has nolhing 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 attemptsC. Total number of subscribers ETC is responsible for recertifying (A-B)
Recertifi cation Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number ofel 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 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 recertify through ETC direct outreach attempt
the number ol Lifeline 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 0 1 0 8 5 14
B.0 0 0 0 0 0 0 0 0 0 0
C.0 0 0 0 0 0 0 0 1 0 I 5 14
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
D.0 0 0000 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 00 0 0 0 0 0 0 0
Jan Feb l\lar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
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 's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number ol 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:
Solix
K. Subscribers de-enrolled as a result of a third party recertification attempt
the number ofsubscribers as a result of or to outreach from a state administrator 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 administrator or USAC
Certification:
Recertifi cation Method: Database
i certify that the company iisted above has procedures in place to receftify consurner 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
Apr May JunJanFebMar Jul Aug S.p Oct Nov Dec Year
Total
I.0 0 0 0 0 0 0 0 1 0 8 5 14
Jan Feb Mar Apr May Jun Jul Arg Sep Oct Nov Dec Year
Total
K.0 0000 0 0 0 0 0 1 1 2
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
L.0 0 0 0 0 0 0 0 1 0 7 4 12
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
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 RK
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 listeci
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,
Robert Kraut,General Manager Robert Kraut, General Manager
Signature of Officer
[e-mail]
Email Address of Officer
Josie Simons
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 30, 2018
Date
2083264331
Contact Phone Number
M = (G+K)N = (D+F+I)O = M/l.l*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
2 14 14.28o/o
5
Affiliated ETCs
SAC Name
5