20190201Virgin Mobile Form 555.pdf

,:,ii:[il-l PH 2: l0Diane Browning
Counsel, State Regulatory
' I- \II'-/Ii
6450 Sprint Parkway
Overland Park, KS 66251
O: 913-315-9284
[e-mail]
February 1,2019
ldaho Public Utilities Commission
ATTN: Daniel Klein
P.O. Box 83720
Boise, lD 83720-0074
Re: Docket No. GNR-T-I9-01
Dear Mr. Klein:
Please find enclosed a copy of the Form 555 for Virgin Mobile USA, L.P. This form
was also filed with the Federal Communications Commission.
Should you have any questions, please contact the undersigned
Sincerely,
Aiane Erowning
spri nV
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
Deadline: January 31't (Annually)
Does the reporting company have affiliated ETCs? Yes E! No @
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 j(2) of the Communications Act. That Section defines "afiliate" 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. ! I53(2). See also 47
CF.R. Ji 76. 1200.
Affiliated ETC's SAC Affiliated ETC's Name
7
479015 143033426
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certificationformfor each SAC through which it provides Lifeline service)
2018 ID Virgin Mobile USA LP
Rece(ification Year
Assurance Wireless
State ETC Name
DBA, Marketing, or Other Branding Name
(If 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)
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 nonttsage 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 wbject to the non-usage requirements and must also indicate the rutmber of
subscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements? Yes E[ No E[
If yes, record the rutmber of subscribers de-enrolled for non-usage by month in Block Q below.
P 0
Month Subscribers De-Enrolled for Non-Usage
January 2
February 2
March 2
April 2
Mav 2
June 1
July 4
Auzust 2
September 1
October 4
November 1
December 6
Total Subscribers 29
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 Certificatiort Att ETCs must comptete this secrion
I certifu 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 andlor 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.
JFInitial
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 JF
Annual Recertification
Do not leave empty blocks. lf 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 month
B. Subscribers de-enrolled prior to recertification attempts
C. 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
thc nunrber ol'subscribers verified access to a state or federal database.
E. Name of the data source(s) used to verifo consumer eligibility:
State database
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifu (You may also use this section to report subscriber initiated recertifications).
the number of Lifeline subscribers the ETC contacted to obtam rece(ificalion of
G. Subscribers who failed to recertifo through ETC direct outreach attempt
the number of Lifeline subscribers de-enrolled due ETC'S
3
Jan Feb Mar Apr May .Iun Jul Aug Sep Oct Nov Dec Year
Total
A.174 180 248 176 1 4 1 165 123 102 9B 113 111 221 1852
B.2 1 3 2 7 65 6 10 10 11 11 60 1BB
C.172 179 245 174 134 100 117 92 88 102 100 161 1 664
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
D.1 0 0 0 0 0 1000000
Jan Feb Mar Apr Mav Jun Jul Aug sep Oct Nov Dec Year
Total
F 172 179 245 173 134 100 117 8B 102 100 190 1692
Jan Feb Mar Apr Mav Jun Jul Aug Sep Oct Nov Dec Year
Total
G.4 3 1 1 22 1 4 4 0 5 5 8
92
58
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 Lifelure subscribers contacted a state administrator third or USAC lor the
J. Name of third party administrator used to veri$ subscriber eligibility:
K. Subscribers de-enrolled as a result of a third party recertification attempt
the number ofsubscribers as a result of or to outreach fiom a state admrnistrator, third administrator, or USAC
of recertification.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number of subscribers that recertified a from a state third or USAC
Certification:
Recertifi cation Method : Database
I certifu 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 JF
4
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dcc Year
Total
H.172 179 245 173 134 99 113 91 88 99 99 188 1 680
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
I.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
K.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
0
M=(c+K)N = (D+F+I)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
recertification who were de-enrolled
58 1 693 3.43%
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.
Initial JF
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
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,
Jay M. Franklin, Assistant Controller Jay M. Franklin, Assistant Contrc
Signature of Officer
Jay. [e-mail]
Email Address of Officer
Andy M. Lancaster
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 31 ,2019
Date
913-762-6107
Contact Phone Number
5
Affiliated ETCs
SAC Name
6