20190110Albion Communications Form 555.pdf

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January 02,2OL9
Carolee Hall
ldaho Public Utilities Commission
PO Box 83720
Boise,lD 83720-0074
Dear Ms. Hall
I am filing a copy of my FCC Form 555 which I have also filed with the FCC and USAC. lf you have any
questions or need additional information, please let me know.
Sincerely,
Kyle Bradshaw
Assistant General Manager
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* (Annually)
Does the reporting company have affiliated ETCs? Yes @ No @
Provide a list of all ETCs that are ffiliated 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 deJines "ffiliate" 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. f 153(2). See also 47
c.r.R. s 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
472213 143002510
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).
2018 lD Albion Telephone Company lnc.
Recertification Year
N/A
State ETC Name
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A " Do ru! 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 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 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 @
If yes, record the rutmber 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
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 Certification ,qil z,rct must complete this section
I certifo 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 andlor 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 authorizedto make this certification for the Study Area Code listed
above.
RRInitial
2
Minimum Service Level
I ceftifu 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 RR
Annual Recertification
Do not leave empty blocks. lf an ETC has nothing to report in a bloch 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 attempts
C. 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
of 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 ofLifeline subscribers the ETC contacted to obtain recertification of
G. Subscribers who failed to recertifr through ETC direct outreach attempt
Lifeline due to or to the ETC's outreach
3
Jan Feb Mar Ap.May Jun Jul Aug Sep Oct Nov Dec Year
Total
A.11 7 2 1 0 1 0 1 1 0 9 5 38
B.0 0 0 0 0 0 0 0 0 0 0 0 0
C.11 7 2 1 0 1 0 1 1 0 I 5 38
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
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total t
F 11 7 2 1 0 1 0 1 1 0 9 5 38
Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
Jan Feb Mar
17G622000011032
H. Subscribers who recertified through ETC direct outreach attempt
the Lifeline subscribers that ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administratoq or USAC
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
H.5 5 0 1 0 1 0 0 0 0 6 3 21
the number ofLifeline subscribers contacted a state third administrator or USAC for the of recertitication.
J. Name of third party administrator used to verify subscriber eligibility:
K. Subscribers de-enrolled as a result of a third party recertification attempt
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
I 0 0 0 0 0 0 0 0 0 0 0 0 0
the number of subscribers 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
lDlllI
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
K.0 0 0 0 0 0 0 0 0 0 0 0 0
the number of subscribers that recertified from a state administrator thirda or IISAC
Certification:
Recertification Method: I)atabase
I certifo that the company listed above has procedures in place to recertifu consumer eligibility by relying on a database. I
am an officer of the company named above. I am authorizedto 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
L.0 0 000 0 0 0 0 0 0 0 0
Recertification Method: ETC
I certifu that the company listed above has procedures in place to recertiflz the continued eligibilify 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.
Initid RR
Recertification Method: Third Party
I certif,, that the company listed above has procedures in place to recertif,, 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 certiflz 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,
Richard Redman Vice President
Signature of Officer
[e-mail]
Email Address of Officer
Julie Laumb
Person Completing This Certification Form
Richard Redman Vice President
Printed Name and Title of Officer
Jan 08,2019
Date
208-673-2208
Contact Phone Number
M = (G+K)N: (D+F+I)O: M/NI*100
Total number ofsubscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent ofsubscribers due for
recertification who were de-enrolled
17 38 44.73%
5
Affiliated ETCs
SAC Name
6