20190124Inland Telephone Form 555.pdf

INLAND TELEPHONE COMPANY
Corporate Offices
103 S 2nd St
P.O. Box 171
Roslyn, WA 98941 - I :::;L pri [': l,i
INI,ANDTELEPHONE
Telephone: [phone]
Fax: [phone] (rru <.- T- lq - o tnp.t
Re
January 24,2OL9
Vla erzna;ll ln ,PDF fornat to dlanc.holt(fuuc.lda.ho.goa
Idaho Rrblic Utilities Commission
Commission SecretarSr
472 W. Washington
P.O. Box 83720
Boise, ID 83720-0074
2OL9 Federal Lifeline Certification and Reporting
hrrsuant to 47 C.F.R. S 54.416(b)
Dear Commission Secretary:
Pursuant to 47 C.F.R. S 54.416(b), accompanying tJ:is letter for
filing with the Idaho Public Utilities Commission ("Commission") is a copy
of the completed Federal Communications Commission ("FCC") Form 555
(Annual Lifeline Eligible Telecommunications Carrier Certilication Form),
for the reporting year ended December 31, 2OL8. The FCC Form 555 has
been electronically submitted pursuant to the FCC's Lifeline program
rules and WC Docket No. 14-171 by Inland Telephone Company
("Compan/XSAC 4724231 to the Universal Service Administrative
Company and the FCC with respect to the Company's Lifeline service
subscribers residing in the State of Idaho.
Please let us know if the Commission has any questions regarding
the information presented on the accompanying form.
Sincerely,
ames K, Brooks
Tbeasurer/Controller
Accompanying document
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: January 31,l- (Annually)
Does the reporting company have affiliated ETCs? Yes @ No @
Provide a list of all ETCs that are ffiliatedwith the reporting ETC, usingpage 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)
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
cF.R. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
472423 143002527
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 ID lnland Telephone Company
Recertification Year
N/A
State ETC Name
Western Elite lncorporated Services
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
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 EI
Ifyes, record the number ofsubscribers de-enrolledfor non-usage by month in Block Q below.
P 0
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
May 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 ott Alt ETCs must 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.
JKBInitial
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 JKB
Annual Recertification
Do not leave empty blocks. lf an ETC has nothing to report in a block, enter a zero.
Report the number ofLifeline 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 recertifring (A-B)
Recertifi cation Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
verified access to a state or federal database.
E. Name of the data source(s) used to verif) 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 of Lifeline subscribers the ETC contacted to obtain recertification ofel
C. Subscribers who failed to recertifr through ETC direct outreach attempt
number of Lifeline due to or to the
3
Jan Feb Mar Ap.May Jun Jul Aug sep Oct Nov Dec Year
Total
A 0 0 0 0 0 0 0 0 0 0 0 0 0
B.0 0 0 0 0 0 0 0 0 0 0 0 0
C.0 0 0 0 0 0 0 0 0 0 0 0 0
May 0ct Dec Year
Total
Jan Feb Mar Apr Jun Jul Aug Sep Nov
D 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Fcb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
F 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
G.0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers who recertified through ETC direct outreach attempt
the number of Lifeline 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 administrator.or USAC for the of recertification.
J. Name of third party administrator used to verily 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 administrator, third administrator, or USAC.
L. Subscribers who recertified through a state administrator, third party administrator, oTUSAC's recertification effort
the number of subscribers that recertified a from a state administrator third administrator or USAC
Certification:
Recertifi cation Method: Database
I certifu that the company listed above has procedures in place to recerti! 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 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 MayJanFebMar Jun .Iul Arg Sep Oct Nov Dec Year
Total
I 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Ap.May Jun Jul Aug 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.
y1i11n1 JKB
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 JKB
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,
James K. Brooks, Treasurer/Controller James K. Brooks, Treasurer/Cor
Signature of Officer
[e-mail]
Email Address of Officer
James K. Brooks
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 23,2019
Date
509) 649-2211
Contact Phone Number
5
14 = (G+K)N = (D+F+I)O = M/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
0 0 0.0%
Affiliated ETCs
SAC Name
522423 lnland Telephone Company
6