20190131Fremont Telcom Form 555.pdf

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1221 Nortn Russeit St i M ssotrla MT 59808
866- 541-500U I Blackfoot.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
Fremont Telcom Co. 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 filing has been electronically
filed in accordance ldaho Public Utilities Commission staff guidance.
Sincerely,
{?i d,,'Jl" O,^o-
Michelle Owens
Regulatory Specialist
Fremont Telcom Co.
1221 N. RussellSt.
Missoula, MT 59808
cc: USAC High Cost Low lncome Division
FCC Secretary
Annual Lifeline Eligible'l'eleconrmunications Carrier Certification llorm All carricrs l'nust colnplete all or porticxs
of all sections l;onn rnust be suburitted to USAC ancl filed rvitlr thc Federal Conrnrunications Conrnrission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadlina: Januarl' 3 1il (Annunlly)
Does the reporting company have affiliated ETCs? Yes EI No Eil
C.F.R.,t 76. 1200.
Affiliated ETC's SAC Affiliatcd ETC's Narne
1
472222 143002515
Study Area Code (SAC) Service l\'ovider Identification Nunrber (SPIN)
2018 ID Fremont Telcom Co
Recertification Year
N/A
State ETC Narne
BTC HOLDINGS INC
DBA, Marketing, or Other Brandinrq Name
lll .silme o.s L,'l'(' nune, /rs/ ".\i{ " l)tt tutt leaye blutk)
Holding Cornpany Narne
(ll-sunr<,as l')T(' runrc. list ".\'.:.1" Do not leuv ltlanll
ETCs Subject to the Non-Usage Requirements
st itscri he rs lc-en rc I led' b)' mon t h.
Is the ETC subject to the non-usage requirements? Yes Bn No Eil
lJ-.t'cs, record the nttnbar ol sultscribars de-cnrollul .lbr u<ttt-usagc by month in Bloc'k Q ltalot.
P o
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
Apdl 0
May 0
June 0
July 0
August 0
Septernber 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 fonnation,
or other similar legal docunrent. 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 lbr operatiorrs, vice presidenl for finance,
comptroller, treasurern or a comparable position. If the flrler is a sole proprietorship, the owner must sign the certification.
Initial Certificatiorl .4tl ltT'cs nwst conqttete this secrion
I certify that the company listed above has certification procedures in place to:
A) Review income and prograrn-based eligibility documentation prior to enrolling a consurner in the Lifeline prograrn, and
that, to the best of rny knowledge, the company was presented rvith docurnentation of each consumer's household
income and/or program-based eligibility prior to his or her enrollment in Lif'eline; 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 consumer in the Lifeline prograln.
I am an officer of the company named above. I am authorized to make this certification for the Study Area Code listed
above.
SMInitial
2
Minimum Service Level
I cerlify thal the company listed above is in cornpliance 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 sm
Annual Recertification
Do not laorc enptr bloc'ks. ll tur ETC hus uothittg to rcport iil u ltktck, cntar u :cttt.
Rcport the nunrber ot'Lif'cline subscritrcrs due lirr rercrtilicatitrrr by morrth (January-Decenrtrcr)A. Subscribcrs cligiblc tbr rcscrtit'ication b-v" annivcrsary rnonthB. Subscribcrs dc-cnrollutl prior ttr rccertificatiorr attcrnptsC. Total nunrbcr of subscritrers ETC is ru'sponsiblc tbr recenitying (A-B)
State of federal databaseD. Subscribers rc'ccrtitled through ETC access to statc or tcderal database by annir,crsary nronth
ilcccss to
E. Nanre ofthc data source(s) used to verifo crnsunrer eligibility:
ETC Direct ContflctF. Subscribers contacted by E-fC directly to reoertify (You nray also use this section to rcport subscriber initiated recertifications).
the nuurber of Lit'clinc the to obtain recenification ol'
G. Subscribers ufio failed to recerti[i thrcrugh ETC direct outrcach attenrpt
(luc to to $c til("s
3
I.'cb i\lnr Apr i\l at'Jun Jul Aug scp Oct Nov Dcc Year
Total
A.6 6 2 2 0 2 1 0 2 5 2 4 32
u 0 0 0 0 0 0 0 0 0 0 0 0 0
C 6 6 2 2 0 2 1 0 2 5 2 4 32
.lan Fcb llar Apr I\ I a1'Jun Jul Aug sep 0ct Nov Dcc Year
Total
I)0 0 0 0 0 0 0 0 0 0 0 0 0
Dec Ycar
Totnl
Jan Fch !l ar Apr illa1'Jun Jul Aug scp Oct Nor'
F 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Fcb Il ar Apr lll a1'.l un Jul Aug Scp Oct Nov Dcc Ycar
Total
G 0 0 0 0 0 0 0 0 0 0 0 0 0
Recertification Vlethods
Jan
H. Subscrihcrs u,lro recertilled through E1'C dirL'ct outrErch tltcnlpt
lhc nurrrbcr ol' Lr li'line subscribe'rs thut rL'ccrlilic(l I: I (''s outreach
Third Partyl. Subscritrcrs rvlrosc cligihility rvas rcviclecl by statc adnrinistra()r, third prrty administrirkrr. or USAC
the nunrbcr ol' LilLline subscribes contactc.rl il st:ttc il(lDrinislratu. thir(l athninistnrtor or [jSA(' lirr the ol recerlrlicitti0r.
J. Namc olthird party adrninistrarcr uscd to verily subscribcr eligibility:
USAC
K. Subscribcrs de-enrollcd as a rcsult ofa third pany recertification attetnpl
thc' nurnber of subscribers as a rcsult ot'or to outre{ch liom a statc arlnrinislrator, third adnrinishator,or USAC'
L. Subscribers who rc.certified thmugh a state adnlinistrator. third party adnrinistrator, or USAC's rece(itication cftbn
thc nrunbqr ol'subscribers that recenilied liom a statc admrnrstrator, thid adrninistrator ol tlS..\('a
Certification
Recertification Method: Database
I certify that the company listed above has procedures in place to recertify consurner eligibility by relying on a database. I
am an officer of the cornpany named abovc. I am authorized to make this certification for the SAC(s) listed above.
Initial _
4
Apr I\la1,lan Fch Ilar Jun ,lul Aug Scp Oct Nov l)cc l'ear
Total
H.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Fcb i\l ar Apr Ilnl'Jun .lul Aug Sep Oct Nov Dt'c Ycar
Total
I 6 6 2 2 0 2 1 0 2 5 2 4 32
Jan Fcb i\Inr Apr Ma1 Jun Jul Aug Sep Oct Nov Dcc Ycar
Total
K,4 2 2 1 0 1 1 0 1 1 0 1 14
Jan Feb llar Apr [Ia1.Jun Jul Aug scp Oct Nov Dcc Year
Totsl
L-2 4 0 1 0 1 0 0 1 4 2 3 18
I
Reccrtification Mcthod: ETC
I certify that the company listed above has procedures in place to recertify the continuecl eligibility ol all of its Litbline
subscribers, and thal, to the best of rny knowledge. the cornpany obtained sigred certifications frour all subscribers attesting
to their contirluing eligibility fbr Lifeline. I am an officer of the cornpany named above. I aur authorized to rnake this
certification for the SAC(s) listed above.
Initial
Recertification Method:'third Party
I certify that the colnpany listed above has procedures in place to recertily collsumer eligibility by relyirtg on an
administrator. I am an officer of the cornpany narned above. I arn authorizcd to make this certification for the SAC(s)
listed above.
Initial Sm
No Subscribers
I certify that rny colnpany did not clairn federal low income supporl for any Lifeline subscribers for the current Fonn 555
data year. I arn an officer of the company named above. I am authorized to rnake this certification for the SAC listed
above.
Initial
Signature Illock
By signin-e below, I certify that the company listed above is in cornpliance with all federal Lifeline certification
procedures. I aur an officer olthe company namecl above. I am authorized to make this certification for the Srudy
Area Code (SAC) listed above.
Signed,
Stacev Mueller CFO Stacey Mueller CFO
Signature ol Ottccr
smuel [e-mail]
Enrail Adtlrcss of Otliccr
Michelle Owens
Pcrson Cornplcting l'his Ccrtilication Form
Printcd Narnc and Titlc of Ollicer
Jan 23,2019
Date
406-541-5131
Contact Phonc Numbcr
5
l\t = (G+K)N = (D+F+l)O = I\l/N*100
Total number of subscribers de-enrollcd as
a result of rcccrtilication
Total numbcr of subscribers ETC is
responsiblc for rccertifl ing
Perccnt of subscribers due for
recertifi cation rvho rvcre de-enrolled
14 32 43.75o/o
Affiliated ETCs
SAC'Narnc
482235 Blackfoot Telephone Cooperative lnc.
483308 Blackfoot Telephone Cooperative lnc.
6