HomeMy WebLinkAbout20190125CenturyLink - South Form 555.pdf(t,M4 , i9- ct t
Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers must complete all ot' h&(iqrls;
of all sections Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST' :, F'lt l, ; r
Deadline: January 31,l- (Annually)
475103 143005231 $t.rtL,
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certification form for each SAC through which it provides Lifeline semice).
2018 ID CenturyLink Qwest Corporation
Recertification Year
N/A
State ETC Name
CENTURYLINK
DBA, Marketing, or Other Branding Name
(If same as ETC name, list "N/A" Do not leave blank)
Holding CompanyName
(lf same as ETC name, list "N/A" Do not leave blank)
Does the reporting company have affiliated ETCs? Yes Eil No Eil
Provide a list of all ETCs that are ffiliated with the reporting ETC, using page 4 and additional sheets if necessary. Afiliation shall be
determined in accordance with Section 3(2) of the Communications Act. That Section defines "ffiliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common ownership or control with, another person." 47 U.S.C. S 153(2). See also 47
c.r.R..$ 76.t200.
Affiliated ETC's SAC lnfntlut.a ETC's Name
-- See attache{worksheet -
l0f\X
1
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthlyfeefrom their Lifeline subscribers are subject
to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number of subscribers 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 number of subscribers de-enrolled for 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
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 offrcer 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 byJaws (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 Certificatiott Att 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 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 authorized to make this certification for the Study Area Code listed
above.
JMAInitial
2
Minimum Service Level
!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.
tnitiat JMA
Annual Recertification
Do not leave empty blocks. If an 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 recertifoing (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the of subscribers or federal database.
E. Name of the data source(s) used to verify 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 of
G. Subscribers who failed to recertify through ETC direct outreach attempt
the of Lifeline subscribers or to the ETC's outreach
3
Jan Fetr Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
A.136 119 74 39 37 32 16 43 42 73 166 186 963
B 0 0 0 0 0 0 0 0 0 0 0 0 0
C.136 119 74 39 37 32 16 43 42 73 166 186 963
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
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
F 0 0 0 1 0 1 0 0 1 0 1 0 4
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
G.0 0 0 1 0 1 0 0 1 0 1 0 4
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.
Name of third party administrator used to verif,, subscriber eligibility:
USAC
K. Subscribers de-enrolled as a result ofa third party recertification attempt
dre number of subscribers as a result of or to outreach fiom a state third administrator or USAC
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the nunber of subscribers that recertified a from a state administrator.third or USAC
Certification:
Recertifi cation Method: Database
I certify that the company listed above has procedures in place to 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 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
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
I 136 119 74 3B 37 31 16 43 41 73 165 186 959
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
K.56 49 34 15 17 I 4 8 10 19 41 50 312
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
L.80 70 40 23 20 22 12 35 31 54 124 136 647
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.
1ni1is1 JMA
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.
1n;1is1 JMA
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
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,
Jerry M. Allen, VP Revenues Jerry M. Allen, VP Revenues
Signature of Officer Printed Name and Title of Officer
Jan 21,2019Jerry.Allen@centurylink.com
Email Address of Officer
Dana Liner
Person Completing This Certification Form
Date
318-362-1834
Contact Phone Number
M: (G+K)N : (D+F+t)o: M/N*100
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent of subscribers due for
recertifi cation who were de-enrolled
316 963 32.81%
5
Affiliated ETCs
SAC Name
160138 United Telephone Company of New Jersey, Inc.
r70209 United Telephone Company of Pennsylvania LLC, The
r90254 Central Telephone Company of Virginia
190567 United Telephone Southeast, LLC (Virginia)
210341 Embarq Florida, Inc.
220356 Coastal Utilities, Inc.
230470 Carolina Telephone and Telegraph Company LLC
230471 Central Telephone Company (North Carolina)
230485 Mebtel, Inc.
240506 United Telephone Company of the Carolinas LLC
250298 Gulf Telephone Company, LLC
259788 CenturyTel of Alabama, LLC (Southem)
259789 CenturyTel of Alabama, LLC (Northern)
270434 CenturyTel of Evangelin e, LLC
2804s8 CenturyTel of North Mississippi, Inc.
290ss2 CenturyTel of Adamsville, Inc.
290557 CenturyTel of Claiborne, Inc.
290567 United Telephone Southeast, LLC (Tennessee)
290574 CenturyTel of Ooltewah-Collegedale, Inc.
300630 CenturyTel of Ohio,Inc.
300661 United Telephone Company of Ohio
310671 CenturyTel Midwest - Michigan,lnc.
3 10689 CenturyTel of Upper Michigan, Inc
310702 CenturyTel of Michigan, Inc.
3 10705 CenturyTel of Northern Michigan, Inc.
320747 CenturyTel of Central Indiana, Inc.
32080 1 CenturyTel of Odon,Inc.
320832 United Telephone Company of Indiana, Inc
33084 I CenturyTel of the Midwest-Wisconsin, LLC (Cencom)
3308s7 CenturyTel of the Midwest-Wisconsin, LLC (Casco)
330877 CenturyTel of Fairwater-Brandon-Alto, LLC
330884 CenturyTel of Forestvill e, LLC
33089s CenturyTel of Wisconsin, LLC
330898 CenturyTel of Larsen-Readfield, LLC
33091 3 CenturyTel of Monroe County, LLC
330922 CenturyTel of the Midwest-Wiscons in, LLC (Northwest)
330924 CenturyTel of the Midwest-Kendall, LLC
33093 l CenturyTel of Southern Wisconsin, LLC
330934 CenturyTel of the Midwest-Wisconsin, LLC (Platteville)
330950 CenturyTel of Northwest Wisconsin, LLC
330956 CenturyTel of Northem Wisconsin, LLC
3309s9 CenturyTel of the Midwest-Wisconsin, LLC (Thorp)
330970 CenturyTel of the Midwest-Wisconsin, LLC (Wayside)
33 I 155 Telephone USA of Wisconsin, LLC
331 159 CenturyTel of Central Wisconsin, LLC
341051 Gallatin River Communications, LLC
Affiliated ETCs
SAC Name
3s1126 CenturyTel of Chester, Inc.
351274 CenturyTel of Postville, Inc.
355 141 Qwest Corporation (Iowa)
36144s CenturyTel of Minnesota, Inc.
361456 Embarq Minnesota, Inc.
365142 Qwest Corporation (Minnesota)
37 1595 United Telephone Company of the West (Nebraska)
375143 Qwest Corporation (Nebraska)
385144 Qwest Corporation (North Dakota)
395145 Qwest Corporation (South Dakota)
401142 CenturyTel of Northwest Arkansas, LLC (Russellville)
401143 CenturyTel of Northwest Arkansas, LLC (Siloam Springs)
401144 CenturyTel of Central Arkansas, LLC
401705 CenturyTel of Arkansas, Inc.
4017 tt CenturyTel of Mountain Home, Inc
401720 CenturyTel of Redfield, Inc.
401121 CenturyTel of South Arkansas, Inc
4tt3t7 United Telephone Company of Eastem Kansas & United Telephone
411842 United Telephone Company of Kansas
41t957 Embarq Missouri, Inc. (Kansas)
421151 Spectra Communications Group, LLC
421957 Embarq Missouri, Inc.
429784 CenturyTel of Missouri, LLC (Central)
429785 CenturyTel of Missouri, LLC (Belle-Herman)
429786 CenturyTel of Missouri, LLC (Southern)
429',t8',7 CenturyTel of Missouri, LLC (Southwest)
442084 United Telephone Company of Texas, Inc
442101 CenturyTel of Lake Dallas,Inc.
442114 Central Telephone Company of Texas, Inc.
442117 CenturyTel of Port Aransas, Inc
442140 CenturyTel of San Marcos, Inc.
455 l0l Qwest Corporation (Arizona)
462185 CenturyTel of Eagle, Inc.
462187 The El Paso County Telephone Company
462208 CenturyTel of Colorado, Inc.
465102 Qwest Corporation (Colorado)
472223 CenturyTel of the Gem State,Inc. (Idaho)
472225 CenturyTel of Idaho, Inc.
475103 Qwest Corporation (Southern Idaho)
475162 Qwest Corporation (Northern Idaho)
482249 CenturyTel of Montana, Inc.
485 104 Qwest Corporation (Montana)
492274 CenturyTel of the Southwest, Inc.
495 105 Qwest Corporation Qrlew Mexico)
505 107 Qwest Corporation (Utah)
5l 1595 United Telephone Company of the West (Wyoming)
Affiliated ETCs
SAC Name
512299 CenturyTel of Wyorning, Inc.
515 108 Qwest Corporation (Wyoming)
s22400 United Telephone Company of the Northwest (Washington)
522408 CenturyTel of Washington, Inc. & CenturyTel of Inter-Island, Inc
522410 CenturyTel of Cowiche, Inc
525161 Qwest Corporation (Washington)
532361 CenturyTel of Eastern Oregon, Inc.
s32361 CenturyTel of Oregon, Inc.
532400 United Telephone Company of the Northwest (Oregon)
535 163 Qwest Corporation (Oregon)
s52223 CenturyTel of the Gem State, Inc. (Nevada)
552348 Central Telephone Company (Nevada)