20200121Fremont Telcom Form 555.pdf

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Lifeline Re-Certification - FCC Form 555
,ir20 JAH 2 I Atl 9: 32
uitU
JJ
January 17,2020
ldaho Public Utilities Commission
472 W. Washington
Boise, lD 83720
Re: WC Docket No, 14-'171 and IPUC Case Number GNR-T-20-01
Fremonl Telcom Co. Respectfully submits the attached cerliflcations purcuant 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.
Please note that Blackfoot is not responsible for recertications of Lifeline consumers in Montana or ldaho. The
directions for form 555 specifically direct filers lo only include data for those subscribers they were responsible for
certifying. Since Montana and ldaho are National Verifier states all recertifications are administered by USAC,
lf you have questions regarding this filing please feel free lo contacl me by e-mail at [e-mail] or
by phone at 406-541-5131,
Sincerely,
t/Lt, ol*tL Cw /rKA-'
Michelle Owens
Regulatory Specialist
Fremont Telcom Co.
1221 N. Russell St.
Missoula, MT 59808
cc: USAC High Cost Low lncome Division
FCC Secretary
472222 14300251 5
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecot lt tunicatiorls Carrier (ETC) must provide a certi,ficarionfonn -lbr esch SAC through ,'thich it provides Lifeline sereice)
201S ID Fremont Telcom Co.
Recertification Year
N/A
State ETC Name
BTC HOLDINGS INC
DBA, Marketing, or Other Branding Name
(lf same as ETC nume, list "N/A" Do not ledw blan*)
Holding Company Name
(A sane as ETC nane. list 'N/A Do nol leave blank)
Annurl Lifeline Eligible Telecommunications Carrier Certification Form AII carriers must complete all or portions
of all sections Form must be submitted to USAC and hled with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 3Ist (Annually)
Does the reporting company hrve alfilieted ETCs? Yes Eil No IO
Provide a list ofall ETC\ that are afrliated with the reporting ETC, using page 4 and addilional sheets d necessary. Afiliation shall he
determined in accordance with Secrion 3Q) ofthe Comdunicotions AcL That Section deJines "alrtliate" as "a petson lhot (direclly or indireclly)
owns or controls, is otned or controlled by, or is under eommon ownership or conffol with, another person." 17 U.S.C. $ 153(2). See also 47
c.F.R. { 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
1
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropiate check-box. ETC| that do nol ossess ond collecl a monthly fee from their Ltfeline subscribers are subject
to the non-usage requircmenls. ETC| suhject to the oh-usage requirctfients must ihdicate the nurnher ofsubscibers de-enrolled by month in
Seclion 4. ETCI that only assess a fee but do not collect such kes ale subject lo the non-usage require.fienll and must ako indicate the number of
subscibers de-enrolled by monlh.
Is the ETC subject to the non-ussge requirements? Yes E[ No E[
Ifyes, record the number ofsubscibers de-enrolledfor non-usage by month in Block Q below,
P 0
Month Subscribers De-Enrolled for Non-Usage
January
Februarv 0
M arch
April 0
May
June 0
July 0
August 0
September
October 0
November 0
December 0
'fotal Subscribers 0
For purposes ofthis filing, an officer is an occupant ofa position listed in the article of incorporation, articles offormation,
or other similar legal document. An offrcer is a person who occupies a position specilied in the corporate by-laws (or
partnership a$eement), and would t)?ically be president, vice president for operations, vice president for finance,
comptroller, treasurert or a comparable position. Ifthe filer is a sole proprietorship, the owner must sign the certification.
Initial Certific8.ti0,n ,l trcs nust complete rhis section
I certiry that the company listed above has certification procedures in place to:
A) Review income and progam-based eligibility documentation prior to enrolling a consumer in the Lifeline progrzrm, and
that, to the best of my knowledge, the company was presented with documentation of each consumer's household
income and/or pro$am-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 ofeligibility 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.
SMInitial
2
0
0
0
0
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
54.408.
I am an officer of the company named above. I am authorized to make this ce(ification for the SACs listed above.
Initial sm
Annual Recertification
Do not leave empty blocks. If an ETC has nothing to repon in a block, enler a zero.
Report the numbcr of Lifeline subscrib€rs due for recertilication by month (January-December)A. Subscribers eligible for rectrtification by annivercary monthB. Subscribers de.enrolled prior to recenification atternptsC. Total number ofsubsoibers ETC is responsible for receftirying (A-B)
Recertification Methods
State of federrl datsbsseD. Subscribenj recsnified through ETC access to statg or fcderal database by anniversary month
R ihc number of subscribeis verified access to a state or ledei'al database.
E. Name ofthe data sourc€(s) used to verify consumer eligibiliry
thc number of Lifcline subscribes the ETC contacted to obtai, re.ertification of
G. Subscribers who t'ailed to recediry through ETC direct outreach attempt
thc number of Lifcline subscribers de-enrollL{ duc to lo the ETC s outrcach
feb \f{ r Apr Ma!Jun Jul Aug sep Oct Dec Yesr
Totrl
C 0 0 0 0 0 0 0 0 0 0 0
3
Jan Feb lU ar APr Nlr)Jun Jul Aug sep Oct Nov Drc YGsr
Total
0 0 0 0 0 0 0 0 0 0 0 0
B,0 0 0 0 0 0 0 0 0 0 0 0
C 0 0 0 0 0 0 0 0 0 0
Mr!Dec Yetr
Tot!l
Jan Feb lll ar Apr Jun Jul Aug sep Oct
0 0 0 0 0 0D000
NlrI Jun .l ul Aug sep Oct Dcc Year
'l otsl
Jan Feb lll ar Apr
F 0 0 0 0 0 0 0 0 0 0 0 0
0
0 lololo
0 0 0 0
ETC Direct ContrctF. Subscribers contacted by ETC direrctly to rec€rtiry (You may also use this section to r€port subscriber initiated recertifications).
0
Jall
0 0I
H. Subscribers who recertified through ETC direct outrcach attempt
the numbrr ofLifelin€ subscribers that succcssfirl recertilied EIC's outreach attem
Third PartyL Subscribers whose eligibility was reviewed by statc administrator, third party administrator, or USAC
the number of Lifcline subscribers conlacted a state administr-ator, third administrator. or USAC for thc of recc(ification.
J. Name ofthird party administrator used to vsriry subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third pafty rccertification attempt
the number of subscribers as a rcsult of to oufeach 1ircm a slate administrator. third administrator. or USAC
L. Subscribers rvho rgcenified through a statc administralor. third par$, administrator, or USAC'S recertification effon
thc number of subscribers thal rccertified ucsl tiom a slate administrator. third adrninisralor. or (JSAC
Certification:
Recertification Method: Dttabase
I certifo that the company listed above has procedures in place to recertifr consumer eligibility by rellng on a database. I
am an officer ofthe company named above. I am authorized to make this certification for the SAC(s) listed above.
4
Jan l'el,l\lar Apr Ntay Jun Jul Aug sep Oct Nov Dec Yesr
Totsl
ll 0 0 0 0 0 0 0 0 0000
.len Feb l\t ar Apr Nl ry .lun Jul Aug sep Oct Year
Totol
I 0 0 0 0 0 0 0 0 0 0 0 0
Jon Feb Msr Ap.May Jun Jul Aug Sep Oct Dec Yerr
Tot!l
K,0 0 0 0 0 0 0 0 0 0 0 0
Jan 1'eb Il ar Ap.NIa)Jun Jul sep Oct Dec Yerr
Totsl
L.0 0 0 0 0 0 0 0 0 0 0 0
0
Dec
0
0l
Aug
0
Initial
Recertification Methodr ETC
I certii, 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 ofmy knowledge, the company obtained signed certifications fiom all subscribers attesting
to their continuing eligibility for Lifeline. I am an offrcer of the company named above. I am authorized to make this
certification for the SAC(s) listed above.
lnitial
Recertification Method: Third Party
I certiff that the company listed above has procedures in place to recertiry consumer eligibility by relying on an
administrator. I am an officer ofthe company named above. I am authorized to make this certification for the SAC(s)
listed above.
Initial sm
No Subscribers
I certifu 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 ofthe company named above. I am authorized to make this certification for the SAC listed
above.
Initial
M = (G+K)N = (IlrF+I)o = )1,/N*t00
Total number of subscribers de-enrolled as
s result of receitirication
Total number ofsubscribers ETC is
.esponsibl€ for recertifying
Percent of subscribers due for
recertifi cation who were de.enrolled
0 0 0.0%
Signature Block
By signing below, I certiry that the company listed above is in compliance with all federal Lifeline certification
procedures. I am an officer ofthe company named above. I am authorized to make this certification for the Study
Area Code (SAC) listed above.
Signed,
Stacey Mueller, CFO Stacey Mueller, CFO
Signature ofOfficer
[e-mail]
Printed Name and Tille of Officer
Jan'17,2020
Email Address of Officer
Michelle Owens
Person Completing This Cenification Form
Date
4065415131
Contact Phone Number
5
Affiliated ETCs
SAC Name
482235 Blackfoot Telephone Cooperative lnc.
483308 Blackfoot Telephone Cooperative lnc.
6