20190204Boomerang Wireless Form 555.pdf

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January 2,2OL9
Diane Hanian, Commission Secretary
ldaho Public Utilities Commission
P.O. Box 81720
Boise, lD 83720-0074
RE: Docket GNR-T-19-01-FCC Form 555 Filed on behalf of Boomerang Wireless ,ILC dlbla enTouch
Wireless
Dear Ms. Hanian,
Boomerang Wireless, LLC dlb/a enTouch Wireless was designated a Lifeline Broadband Provider by the
FCC on December L,2076. Pursuant to FCC requirements under 47 C.F.R. 5 54.422, enclosed please find
a copy of the FCC Form 555 that was filed with USAC. We are also required to provide a copy to you.
lf you have any questions regarding this filing, please contact me at [phone] or
[e-mail]
lly su
Julia Carter
Regulatory & Compliance Officer
Boomerang Wireless, LLC d/b/a enTouch Wireless
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: Januory 31't (Annually)
Does the reporting company have affiliated ETCs? Yes E[ No E[
Provide a list of all ETCs that are affiliated wilh the reporting ETC, using page 4 and additional sheets if necessary. Affiliation shall be
determined in accordance with Section 3(2) of the Communications Act. That Section defines "affiliate" as "a person that (directly or indirectly)
ovtns or controls, is owned or controlled by, or is under common ownership or control with, another person. " 47 U.S.C. S I 53(2). See also 17
cF.R. $ 76.t200.
Affiliated ETC's SAC Affiliated ETC's Name
479022 143036595
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certificationformfor each SAC throughwhich it provides Lifeline service).
2018 ID Boomerang Wireless LLC
Recertification Year
enTouch Wireless
State ETC Name
N/A
DBA, Marketing, or Other Branding Name
(lf 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)
7
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 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 @
Ifyes, record the number ofsubscribers de-enrolledfor non-usage by month in Block Q below.
P o
Month Subscribers De-Enrolled for Non-Usage
Januarv 22
February 14
March 18
April 18
May 17
June 1B
July 16
August 12
September 19
October
November 9
December 5
Total Subscribers 177
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 ort Att ETCs musr complete this section
I certify that the company listed above has certification procedures in place to:
A) Review income and program-based eligibili[ 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.
KLInitial
2
I
Minimum Service Level
!cerf ify 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 KL
Annual Recertification
Do not leave empty blocks. Ifan 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 recertifying (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
number of subscribers to a state or f'ederal database.
E. Name of the data source(s) used to verify consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifu (You may also use this section to report subscriber initiated recertifications).
of Littline subscribers of ei
G. Subscribers who failed to recertily through ETC direct outreach attempt
the number of de-enrolled due to inel or to
3
Jan Fetr Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year'fotal
A.0 0 0 3 1 1 0 2 0 100 80 135 322
B 0 0 0 2 0 0 0 0 40 49 34 125
C 0 0 0 1 1 1 0 2 0 60 31 1 0 1 197
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 0
Jan Feb Mar Ap.May Jun Jul Aug Sep Oct Nov Dec Year
Total
F 0 0 2 0 00 0 0 0 40 49 34 125
Apr MayJanF'eb Mar Jun Jul Aug sep Oct Nov Dec Year
Total
G.0 0 0 1 0 0 0 0 0 20 2 19 42
0
0
H. Subscribers who recertified through ETC direct outreach attempt
the number of recertified ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number of Lif'eline subscribers contacted a state third administrator. or USAC for the of recertification.
J. Name of third party administrator used to verifo subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third parf recertification attempt
the number of subscribers 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, or USAC's recertification effort
the number ofsubscribers that recertified from a state administrator, third administrator, or USAC
that
a
Certification:
Recertification 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
Apr MayJanFebMar Jun Jul Aug sep Oct Nov Dec Year
Total
H.0 0 1 100 0 2 0 40 29 82 155
Jan Feb N{ar 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 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 certifi 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 KL
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 cuffent Form 555
datayear.l 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 certifo 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,
Kim Lehrman President
Signature of Olficer
klehrman@readywireless. com
Email Address of Officer
Oliver Moeller
Person Completing This Certification Form
Kim Lehrman President
Printed Name and Title olOfficer
Jan 31 ,2019
Date
319-432-3220
Contact Phone Number
5
M:(G+K)N = (D+F+I)O: M/N*100
Total number ofsubscribers de-enrolled as
a result of recertification
Total number ofsubscribers ETC is
responsible for recertiSing
Percent ofsubscribers due for
recertification who were de-enrolled
42 125 33.6%
Affiliated ETCs
SAC Name
6