20190114Boomerang Wireless Form 555.pdf

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WIRELESS
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January 2,2079 G,ua-T- tq-ol
Diane Hanian, Commission Secretary
ldaho Public Utilities Commission
P.O. Box 83720
Boise, lD 83720-0074
RE: Docket GNR-T-18-01-REVISED FCC Form 555 Filed on behalf of Boomerang Wireless,LLCdlbla
enTouch Wireless
Dear Ms. Hanian,
Boomerang Wireless, LLC dlb/a enTouch Wireless was designated a Lifeline Broadband Provider by the
FCC on December L,2OL6. Pursuant to FCC requirements under 47 C.F.R. 5 54.422, enclosed please find
a copy of the REVISED FCC Form 555 that was filed with USAC . We are also required to provide a copy
to you.
lf you have any questions regarding this filing, please contact me at [phone] or
[e-mail]
Respectful ly subm itted,
ls/ Julia Redman Carter
Julia Redman Carter
Regulatory & Compliance Officer
Boomerang Wireless, LLC d/bla enTouch Wireless
Annual Lifelinc Eligiblc Tcleconrmunications Carrier Certification l?ornr All carrierc musl contpletc all ol poltions
of all sections Fonn rnust be submltled to USAC arrd llled rvith thc l.'cdcral Communications Conunission
IMPORTANT: PLEASE RBAD INSTRUCTIONS FIRST
Deodline: Juuutq, 3k (Annurlly)
Does the reportlng company havc aftiliatecl [TCs? yes El No EII
l'rotide o llst aJoll ETCI thot are afiiltotad i,ith thc repotiltg ETC, asingpage I and addilioual shccts lf necesmty. $filiation sholl be
c.t?.R. s 76,t20a.
Affiliated ETC's SAC Affiliated ETC's Name
4lqoLs*143036595
Study Area Code (SAC) Servicc Provider Identification Nurrrber (SPIN)
20t7 fb Boomerang Wireless LLC
Recertification Year
enTouch Wireless
State ETC Name
DBA, Marketing, or Olher Branding Nanre
({sone as lilC uante, list "NLl" Do 1191ko,re htot*)
Holding Cornpany Narne
(fsauc us lilC ranrc, list "N/A" Do trol leo*: blank)
1
ETCs Subjcct to the Non-Usage Rcquiretncnts
subscr i bers d e-c nro I I otl' bt nn n th.'
Is the ETC subject to tlrc non-uscgc requircmcnts? Yes Hl No EJI
[yes, reconl the tnonl:er o/substlbers dc-cnrotladlu'nur-usagc h1, utouth h Bloc* Q belor.
P a
Montlr Subsoibers Dc-Enrolled for Non-Usage
January b
February .xa
March az
April t5
Mav tct
June il
July t+
August q
September {o
October I
Novernber *
December trl
'Iotal Subscribers ,5e
For purposes of this filing, an of icer is an occuparrt of a position listed in tlre article of incorporation, articles of forrnation,
or other sirnilar legal docurnent. An officer is a person who occupies a position specified in the corporate by-lals (or
partnership agreetnent), and would typically be ptesident, vice prcsident for operntions, vice president for financc,
comptroller; treasurcr, or a comparable position. If the filcr is a solc proprietorship, tlre owner must sign the cerlification,
Initial Ccrtificntiofi ill E?cs nurst cotnplatc thls scctton
I certiS that the conlpany listed above has certification procedures in place to:
A) Rcvierv income and prograrn-bascd eligibility docunrenlation prior to enrolling a consumer in the Lifeline program, and
that, to thc best of my knorvledge, the company was presented rvith documentation of each eonsumer's lrousehold
incomc and/or prograrn-based e ligibility prior to his or her enrollment in Lifeline; and/or
B) Confim consutner eligibility by relying upon access to ir stote database and/or notice of etigibility from the statc
Lifeline administrator prior to enrolling a cotlsulner in the Lifcline progmnl.
t am an officer of the company named above. I arn authorized to make this certification for the Study Area Code listed
above.
rnttiat l{4 L
Minimurn Scrvicc Level
!i?6,p.'
that thc company listed above is irr conrpliance rvith the minimum service lcvels sct forth in the 47 CFR Section
I am an officer of the compauy named above. I am authotized to make this certification for llte SACs listed above,
1n;1;n1 I{-4L
Annual Reccrtification
Do not leave enrptl'blocks. Itan ETC hos nothing to reporl in o block, eiltcr o 7ero.
lleport thc nunrbcr ofLihlinc subscribcrs due for n:cer(ilicnlion by rnonth (Janua4.Dcccnrbcr)
A. Subscribcrs cligiblc for rcccrtilication by nnnivcrsory ntontltB. Subscribcrs dc.enrollcd prior to reccrlilicotion nttctttptsC. 'l'ot.rl nunrtrcrof subsribcrs ETC is rcsponsiblc lor rccertilyiog (A-ll)
Rccerlification Methods
Stflte of fc(lcrnl dltnbnscD. .Suhscribcrs rcccrtificd through El'C access l,o $tiltc or fcdcrrtl dntabasc by nnniversnry ntontlt
Ij. Nnmc olthc drtn sourcc(s) uscd to verify consutttcr cligibility:
PDAP
I|TC Dlrcct ContnctI:. Subscribcrs contuctcd by ETC dircctly to rcccnify (You nray nlso usc tlris scction to rcporl subscribcr irritinted rcccrtifieations),
cortlclrd t0 obkiq
C. Subscribcn rvho llilcd to rcccrtify through E'IC dircct outrcnclt ottcnrpt
t[c
,lnn Fch I\Iar Anr Nlry Jun Jul Aug scp Oct Nov Dcc Ycnr
Tolrll
0 0 0 0 0 0 @ b o 6 a U a
lt.0 0 0 0 0 0 @ a a a @ @ @
C.0 0 0 0 0 0 p a @ a a @ b
.lnn Iclr i\lrr r\pr i\Lry .lun Jul rlug s"P Oct Nov Dec Yelr
Totol
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Jnn Feb itsr Apr i\lnl ,tun Jul ,1ug scp Oct Nov Dcc Ytnr
'l'otal
I:,0 0 0 0 0 0 o b @ o o a a
Ycnr
TotnllllnrAprI\Iny .Irrn Jul Aug scp Oct Nov DccJrrnFclr
0 0 o o @ 6 a bO .9G.0 0 0 0
3
II. Sutrscribers rvho rcccrtificd thmugh E'l'C dircct outrcilch ilttcnlpt
Thlrd Pnrtyl. Subscribcrs *'lrosc cligitrility rlns rcvicru:d h)'strte fldorirristrntor, third pnrty rdrninislrator, or USAC
rhc of subscrilxrs contnctcd a Stote third or USAC for lhc ofrccertificntion,
J. Nanrc ofthird party administru(or used to vcrify subscribcr cligibility:
K. Subscribers dc-cnrollcd rls a rcsult ofa lhird p*rty rccertificirtion ilttcnlpt
thc number ofsutrscribcrs as o rcsslt lo oulrcnch from o tl{le third
L. Subscribers rvho rccertificd tlrrough n stntc atlnrinistrator, thinl pfltly rdrninisrator, or USAC's rcce(i{lcrtioil cffort
ihc numbcr of subscribe(s front
or USAC.
Ccrtificntion;
Reccrtlflcatlon Mcthod: Database
I certify that the company listed above has proccdures in place to recertity consunler eligibility by relyirrg on a database. I
an an officer of the conrpany named above. I attt authorizrd to make this certification for the SAC(s) listed above.
lnltlal
l\Iry Yclr
Tolnl
,Inn liclr i\lrrr Apr ,lun ,lul Aug scp Oct Nov Dcc
lt.0 d @ 6 @ o @ @ @ {d c*>0 a
,lln lch i\lrtr rlpr i\ Irtl'.lun Jul Aug scp Oct Nov Dcc I'etr
'l'otol
t.0 0000 0 0 0 0 0 0 0 0
Jun Fcb l\lnr r\pr i\lrp'Jurr .lul At,g scp Oct Nov Dec Ycnr'fotrl
0 0 0K.0 0 0 0 0 0 0 0 0 0
Jrln Irclr i\lur r\pr ilIay Jun .lul Aug scp Oct Nov Dec Year
Totnl
1..0 0 0 0 0 0 0 0 0 0 0 0 0
4
Reccrtification Mcthod: ETC
I cenil'y that the company listcd above has procedures in placc to recertify lhe conlinued eligibility of all of its Lifelirre
subscribers, arrd that, to the bcst ofmy knorvledge, tlre company obtained signed ccrlifications frorn all subscribers attcsting
to tlreir continuing eligibility for Lifcline. I am an officcr of thc company nanrcd above. I arn authorized to make this
certification for the SAC(s) listed above.
rnitirr t/*t-
Ileccrtiflcation Mctlrod: Thlrd Party
I certily lhat tlre company listed above has procedures in place to recertify consumer eligibility by relying on an
adrninistrator. I anr an officer of the company narned above. I am authorized to make this certification for the SAC(s)
listed above.
Inltinl
No Subscrlbcrs
I certi$ that rny conlpany did not claim fcdcral lorv inconte suppon for any Lifbline subscritrers for the current Forrn 555
data year. I anr an officer of the cornpany named above. I arn authorized to makc this ccrtification for the SAC liste d
above,
Inltial
Signature Bloclt
By signing belorv, I ccrtift thal the company listed abovc is in cornpliance rvitlr all fedual Lifeline certification
procedurcs. I am an officer ofthe cornpany nanted above. I anr authorized to make this certification for the Study
Arca Codc (SAC) listed above.
Signed,
Kimberley Lehrman, Pres!{qrt
Signnture Printcd Nmrc nnd'l'itls of Oficcr
[e-mail]
Enrall Addrtxs of Ofllccr
Ollvcr f. Mocller
Pcrson Complc(ing'l'his Ccrtifi cntion l;ornt
t2l24l20ta
l)ntc
3197434641
Conlact Phonc Numbcr
5
i\I E (c+K)N - (D+l.+t)O - lU/Nr100
'l'olol nunrber of subscrlbers dc-cnrollcrl ns
n rcsull of rcccr(ilicntlon
't'ol8l tlunrbcr ofsubscrlhcrs llTC ls
lcspon.riLlc for rcccrlifylng
Pcrccnt ofsubscrlbcrs duc for
rcccrtlficnllon rvllo rvcrc dc-enrollcd
3tP @ t3,ooa/a
Affiliated ETCs
SAC Name
6