20190131Blackfoot Telephone Form 555.pdf

@)Blackfoot
Connect to more i ,; I Jiii 3 I Pi{ 2: 3 3
1221 North Russeit St I M ssorrla MT 59808
866 541-5000 | Elackfoot.com
Lifeline Re-Certification - FCC Form 555
January 31,2019
ldaho Public Utilities Commission
472W. Washington
Boise, lD 83720
Re: WC Docket No. 14-171 and IPUC Case Number GNR-T-19-01
Blackfoot Telephone Cooperative, lnc. respectfully submits the attached certifications pursuant to 47 CFR 554.416
(b) and 54.410 (d) as required by the Federal Communication Commission's Lifeline Reform Order, The liling has
been mailed in accordance with ldaho Public Utilities Commission staff guidance,
Sincerely,
'f)Lot,uW
Michelle Owens
Regulatory Specialist
Blackfoot Telephone Cooperative, lnc.
1221 N. RussellSt.
Missoula, MT 59808
cc: FCC Secretary
Montana Public Service Commission
USAC High Cost & Low lncome Division
Confederated Salish & Kootenai Tribes
Annual Lifclinc Eligihlc Telccommunications Carrier Ccrtification l.'orm All cariers urust cotnplete all or portions
of all sections l;onn must bc submitted to USAC and filed rvith the Federal Communications Comurission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: Januaty 3lt (Annually)
Does the reporting company have affiliated ETCs? Yes E No @
cF.n. s 76.t200.
Affiliated ETC's SAC Affiliated ETC's Name
482235 143002531
Study Area Code (SAC) Service Provider ldentification Nurnber (SPIN)
2018 MT Blackfoot Telephone Cooperative lnc.
Recertification Year
N/A
State ETC Narne
BTC HOLDINGS INC
DBA, Marketin-e, or Other Branding Name
tlf sanrc os ETC numc. /r.st "i\',1'l " l)o !tq! leuve bfunk)
Holding Company Name
(l/'scmrc os El'C nome. list "N/A" Do not lcave blank)
1
E'tCs Subject to the Non-Usage Requirements
srrlrs< r'rlrcr:s d<,-tnntIlctl'lr nrnth '
Is the ETC subject to the non-usage requirements? Yes @ No E[
l[.t'cs, reconl thc ntrnher of snbso'iltcrs le-enntllul .fitr non-usuga b.1' nnuth in Block Q belov.
P o
Montlr Subscribers Dc-Enrolled for Non-Usage
January 0
Februarr-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 occuparrt of a position listed in the article of incorporation, articles of formation,
or other sirnilar legal document. An officer is a person who occupies a position specified in the corporate bv-laws (or
partnership agreement), and lvould 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 olvner must sign the certification.
Initial Certificatiott tlt ETCs must t'onplere this section
I certify that the colnpany listed above has certihcation procedures in place to:
A) Review income and program-based eligibility documentation prior to enrolling a consumer in the Lil'eline program, and
that, to the best of rny knowledge, the colupany was presented with docurnentation of each consumer's household
income and/or program-based eligibility prior to his or her enrolhnent in Lifeline; and/or
B) Confinn consurner eligibility by relying upon access to a state database and/or notice of eligibility frorn the state
Lifeline adrninistrator prior to enrolling a consulner in thc Lifeline program.
I arn an officer of the company named above. I am authorized to rnake this cerlification fbr the Study Arca Code listed
above.
smInitial
2
Minimum Service Level
I certify that the company listed above is in compliance with the minimunr sen'ice levels set forth in the 47 CFR Section
54.408.
I arn an officer of tlre company narned above. lam authorized to make this certification for the SACs listed above.
Initial sm
Annual Recertification
Do not leavc anptyblocks. ll on ETC has nothing to report in a bloc'k. enler u :cro.
Report the nunrber ofLitbline subscribers due firr rcccrtification by nronth (January-Dcccmbcr)A. Subscribcrs eligiblc fbr reccrtitication by annivcrsary monthB. Subscribcrs dc-cnrollcd prior to rccertification attcnrptsC. Total numbcr olsubscribcrs ETC is rcsponsible tbr reccrtitying (A-B)
Recertifi cation Nlethods
State of federal database
D. Subscribers rcccrtitiecl through ETC access to state or tbderill database by anniversary nronth
the number of subscnber verified access to a state or l'etleral database.
E. Nanre of the data sourcc(s) u5ed to r,eriry consumcr cligibility:
ETC Direct ContactF. Subscribcrs contactcd by ETC clirectly to reccrtily (You rnay also usc this section to rcporl subscribcr initiatetl reoertiticationsl.
the numbcr of [.il'elinc subscnberu the E'l'C contacted to obtaiil
C. Subscribcrs sho tailcd to recertity through ETC dircct outrc-ach atlcnrpt
the nrunber ot'[.ilLlinc subscribcrs de-enrolletl due to or to the L I ("s outrtach
3
Jan Fcb Mar Apr lllay Jun Jul Aug sep Oct Nov Dec Year
Totrl
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
.lan Feh llar Apr ill a1'.lun Jul Aug Scp Oct \ov Dcc Year
Total
0 0D,0 0 0 0 0 0 0 0 0 0 0
Jan t'eh i\lar Apr illa1'Jun Jul Aug Sep Oct Nov Dec Year
Totnl
F 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Scb Nl ar Apr lla1.Jun Jul Aug Sep Oct \ov Dec Year
Total
G.0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers rvho recertilierl through [:'l'('direct outrcach altcrnpt
thc nunther ol l.ilelrne subscrihcrs that rrcsrlilie(l l: I("s outleach
Third Partyl. Subscribcrs rvhosc cligibility was ro,iervcd by state adrninistrator. third party administrator. or [JSAC
the nurnber ol'Littline subscribers contacted a stnte adlrinisl.rfllor. third adninistrator. or tiS?\( lbl the
J. Narnc of third party administrator uscd to vcrify subscribcr eligibility:
K. Subscribcrs dc-enrollcd as a rcsult ofa third party recertitication attenlpt
the nuurber of subscribers as a result of or to oulreach lionr a statc adrnirristrator, third administrator, or USAC
of recertilication.
L. Subscribcrs rvho reccrtiticd through a statc administrator. third party adnrinistrator, or t)SAC's rcccrtitication cftbrt
the number ofsubscribers that reccrlifietl linrn a state adurinistmtor. third adlninistmtor, or USACa
Certification
Recertifi cation Method: Database
I certifr that the cornpany listed above has procedures in place to recertify consumer eligibility by relying on a database. I
am an officer of the company narned above. I am authorized to rnake this certification for the SAC(s) listed above.
4
r\pr l\l a1'Jun Oct Nov Dcc Yclr
Tolal
Jan Feh Ilar Jul Aug Sep
H 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Fch llnr Apr \la1 Jun Jul Aug scp Oct Nov Dcc Yenr
Totrl
I 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb trlar Apr I\,1a.v"Jun .lul Aug sep Oct Nor'Dec Year
Total
K.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Fcb ll ur Apr IInl'Jun .lul Aug Sep Oct Nor'Dcc Year
Total
L.0 0 0 0 0 0 0 0 0 0 0 0 0
lnitial_
I
Recertification Method: ETC
I certify that the company listed above has procedures in place to recenify the continued eligibility of all of its Lifeline
subscribers, and that, to the best olrny knowledge. the cornpany obtained signed certifications from all subscribers attesting
to their continuing eligibility fbr Lif'eline. I arn an oflcer of the cornpany named above. I am authorized to urake this
certification for the SAC(s) listed above.
lnitial
Recertification lVlethod: Third Party
I certify that the cornpany listed above has procedures in place to recertify consuurer eligibility by relying on an
adrninistrator'. I ant an ofTicer of the company named above. I am authorized to rnake this certification for the SAC(s)
listed above.
Initial sm
No Subscribers
I certify that rrry cornpany did not clairn federal low incorne support for any Lifeline subscribers for the current Fonn 555
data year. I aln an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial
Signature Block
By signing belo'uv, I certify that the cornpany listed above is in cornpliance with all federal Lifeline certification
procedures. I arn an officer of the company named above. I aur authorized to rnake this certification for the Study
Area Code (SAC) listed above.
Signed,
Stacc'l Mucller CFo Stacey Mueller CFO
Signaturc of Of'ficer
s muel ler@bl ackfoot. com
Email Address olOlficcr
Michelle Owens
Person Cornplcting This Ccrtification Fonn
Printed Namr'and Titlc of Olllccr
Jan 23,2019
Datc
406-541-5131
Contact Phrrrre Nunrber
5
Nl = (G+K)r.. = (D+t+l)O = lvl/N*100
Total numher of subscribers de-enrolled as
a result of rcccrtification
Total number of subscribers ETC is
rcsponsible for reccrtiff ing
Perccnt of subscribers due for
recertifi cation rvho rvere tle-enrolled
0 0 0.0o/o
Affiliated ETCs
SAC Nanre
483308 Blackfoot Telephone Cooperative lnc.
472222 Fremont Telcom Co.
6