20190206QLink Wireless Form 555.pdf

Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carier (ETC) must provide a certification form for each SAC through which it provides Lifeline semice).
2018 tD e Link Wiretess LLC
47901 8 143036544
StateRecertification Year
N/A
ETC Name
QUADRANT HOLDINGS GROUP LLC
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)
Qrvn- r- lq-o /
Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers must complete'all-oi irdrUftB
of all sections Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE RBAD INSTRUCTIONS FIRSTT: -5
Deadline: January 31't (Annually)
fit{ 9: hB
' ! l/aI :-iu
Does the reporting company have affiliated ETCs? Yes En No @
Provide a list of all ETCs that are affiliatedwilh the reporting ETC, usingpage 4 and additional sheets if necessary. Afiliation shall be
determined in accordance with Section 3(2) of the Communications Act. That Section defines "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
cF.R. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
t
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 fron 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 of subscribers de-enrolled for non-usage by month in Block Q below.
P o
Month Subscribers De-Enrolled for Non-Usage
January 109
February 118
March 251
April 197
May 134
June 131
July 105
August B3
September 54
October 52
November 36
December 30
Total Subscribers 1 300
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 olri All ETCs must complete rhis section
I certify 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 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.
IAInitial
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 lA
Annual Recertification
Do not leave empty bloclcs. 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 monthB. Subscribers de-enrolled prior to recertification attemptsC. Total number of subscribers ETC is responsible for recertilling (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of subscribers venfied access to a state or federal 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)
the number of Lifeline subscribers the ETC contacted to obtain recertification of
G. Subscribers who failed to recertif through ETC direct outreach attempt
the number of Lifeline subscribers de-enrolled due to or to the ETC's outreach
3
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
A.560 811 759 702 666 505 698 1018 797 936 805 897 9154
B.0 0 14 42 54 53 85 118 90 113 114 1 1 1 794
C.560 811 745 660 452 613 900 707 823 691 786 8360
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
Dl lrl
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
F 560 811 745 660 612 452 613 900 707 823 691 786 8360
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
G.0 323 257 205 187 137 172 227 165 189 163 178 2203
612
0
H. Subscribers who recertified through ETC direct outreach attempt
the number recertified
Third Party
L Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number of Lifeline subscribers contacted a state administrator third administrator, or USAC for the of recertification.
J. Name of third party administrator used to verify subscriber eligibility:
K. Subscribers de-enrolled as a result of a third party recertification attempt
the number of subscribers as a result of rnel or to outreach from a state third
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number ofsubscribers that recertrfied a from a state adm third or USAC
that
or USAC.
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
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
H.560 488 488 455 425 315 441 673 542 634 528 608 6157
Jan Ap.N'IayFebMar Jun Jul Aug sep Oct Nov Dec Year
Total
I.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Apr MayFebMar 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 Sep Oct Nov Dec Year
Total
L.0 0 0 0 0 0 0 0 0 0 0 0 0
Aug
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 lA
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,
Issa Asad-CEO
Signature of Olficer
lssa@q uadrantholdings.com
Email Address of Officer
Maybell Kelly
Person Completing This Certification Form
lssa Asad-CEO
Printed Name and Title of Officer
Feb 05, 2019
Date
800-610-1540
Contact Phone Number
5
M = (G+K)N = (D+F+r)o = M/1.,1*100
Total number ofsubscribers de-enrolled as
a result of recertification
Total numtrer of subscribers ETC is
responsible for recertiSing
2203 8360 26.35o/o
Percent ofsubscribers due for
recertification who were de-enrolled
Affiliated ETCs
SAC Name
6