20190204Filer Mutual Telephone Form 555.pdf

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Telephone Company
January 31,2019
Ms. Diane Hanian
Commission Secretary
Public Utilities Commission of ldaho
472W Washington
Boise, lD 83702
RE: IPUC Docket GNR-T-I9-01: Annual Lifeline Certification for Filer Mutual
Telephone Company, lnc. in ldaho
Dear Ms. Hanian,
Filer Mutual Telephone Company, lnc. ("the Company" or "File/') is submitting the
attached informational filing to the Public Utilities Commission of ldaho ("Commission")
pursuant to pursuant to 47 CFR 54.416 as adopted by the Federal Communication
Commission (FCC) in its Lifeline Reform Order, FCC 12-11, released February 6,2012.
Section 54.4 16(b) requires eligible telecommunication carriers (ETCs) to annually
provide the results of their re-certification efforts performed pursuant to Section 54.4 10
(0 to the FCC and the Universal Service Administrative Company (USAC). ETCs are also
required to provide the results of their recertification efforts to state commissions and
relevant tribal governments.
Please do not hesitate to call me at [phone] if you have any questions.
Sincerely,
4lJ
Robert Kraut
General Manager
Enclosures
tssloi,!
LJ
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: fanuary 31't (Annually)
Does the reporting company have alfiliated ETCs? Yes Eil No E[
Provide a list of all ETCs that are ffiliatedwith the reporting ETC, using page 4 and addilional sheets if necessary. Afiliation shall be
determined in accordance with Section 3(2) ofthe Communications Act. That Section de/ines "afiiliate" 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.r200.
Affiliated ETC's SAC Affiliated ETC's Name
t
472220 143002513
Study Area Code (SAC) Service Provider Identification Number (SP[D
(An Eligible Telecommunications Catier (ETC) must provide a certificationformfor each SAC throughwhich it provides Lifeline semice).
2018 lD Filer MutualTelephone Company
Recertification Year
N/A
State ETC Name
DBA, Marketing, or Other Branding Name
(lf sane as ETC name, list "N/A" Do rct leave blank)
Holding Company Name(f same as ETC name, list "N/A" Do rct 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 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 Eil
Ifyes, record the number of subscribers de-enrolledfor non-usage by month in Block Q below.
P a
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
May 0
June 0
July 0
Auzust 0
September 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 formation,
or other similar legal document. An officer is a person who occupies a position specified in the corporate by-laws (or
parhership 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 Certilicatiort Alt ETCs nust complete this section
I certiff 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 emollment 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.
RSKInitial
2
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
A.2 5 1 0 0 0 0 1 4 21
B.0 0 0 0 0 0 0 0 0 0 0 0 0
C.2 5 1 0 0 0 0 0 1 0 I 4 21
Minimum Service Level
I certifo that the company listed above is in compliance with the minimum service levels set forth in the 47 CFR Section
s4.408:
I am an officer of the company named above. I am authorized to make this certification for the SACs listed above.
tnitial RSK
Annual Recertification
Do not leave empty blocks. Ifan ETC has nothing to report in a block, enter a zero.
Report the number ofLifeline 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 recertiSing (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number verified access to a state or federal database.
E. Name of the data source(s) used to veriff consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertiff (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 recertifr through ETC direct outreach att€mpt
the number of Lifeline subscribers de-enrolled due to or to the ETC's outreach
3
May Jun Jul sep Oct Nov Dec Year
Total
Jan Feb Mar Apr Aug
D.0 0 0 0 0 0 0 0 0 0 0 0 0
olllt
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
F.2 5 1 0 0 0 0 0 1 0 I 4 21
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
G 1 3 0 0 0 0 0 0 1 0 4 1 10
0 0 I
H. Subscribers who recertified through ETC direct outreach attempt
the number 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 third or USAC for the of recertification.
J. Name of third party administrator used to veriff subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party 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 adminishator, third party administrator, or USAC's recertification effort
the number of subscribers that recertified a from a state third or USAC
Certification:
Recertification Method: Database
I certiff that the company listed above has procedures in place to recertiff 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
Jen Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
H.1 2 1 0 0 0 0 0 0 0 3 11
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
I.0 0 0 0 0 0 0 0 0 0 000
Jan Feb Msr Apr 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
4
Recertification Method: ETC
I certiff that the company listed above has procedures in place to recertiff 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 authorizpd to make this
certification for the SAC(s) listed above.
1a;6x1 RSK
Recertification Method: Third Party
I certiff that the company listed above has procedures in place to recertiff 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 certi$ that my company did not claim federal low income support for any Lifeline subscribers for the current Form 555
data year. I am an offrcer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial
Signature Block
By signing below, I certiff 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,
Robert Kraut, COO Robert Kraut, COO
Signature of Offrcer
[e-mail]
Email Address of Officer
Josie Simons
Person Completing This Csrtification Form
Printed Name and Title of Officer
Jan 31 2019
Date
208.326.4331
Contact Phone Number
5
M=(c+K)N = (D+F+D O = M/N*100
Total number ofsubgcribers de-enrolled as
a rcsult of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent ofsubscribers due for
recertification who were de-enrolled
10 21 47 .610/o
Affiliated ETCs
SAC Name
6