20200309ViaSat Carrier Services Form 555.pdf

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COMMPLIANCE
GROUP
March 06,2O2O
ldaho Public Utilities Commission
P.O. Box 83720
Boise, lD 83720-0o74
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RE: VlaSat Carrler Sewices, lnc. - 2020 FCC Form 555 - Annual Ufellne Ellglble
Telecommunlcations Carrler Certlfication
Dear Staff,
Pursuant to FCC requirements under 47 C.F.R. S 54.416, enclosed please find for a copy of
ViaSat Carrier Services, lnc.'s FCC Form 555 -Annual Lifeline Eligible Telecommunications
Carrier Certification. As the filing indicates, the company has not yet begun providing Lifeline
service to ldaho subscribers.
lf you have any questions regarding this filing, please contact me at (703) 7L4-L324 or
ma p@ com m plia ncegrou p.com.
Respectfu lly Submitted,
V iln^a-Q.'
Marsha A. Pokorny
Managing Consultant on behalf of ViaSat Carrier Services, lnc.
1420 Spring Hill Road, Suite,l{X)
Mdean,Virginia 22102
r 703.714.1302
i703.563.6222
w wwn commpliancegroup.com
t mailOcommplianegroup.com
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 afliliated ETCs? Yes Eil No E[
Provide a list of all ETCs that are affliated with the reporting ETC, using page 4 and additional sheets if necessary. Afiiliation shall be
determined in accordance with Section 3(2) of the Communications Act. That Section defines "ffiliate" 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 I 53(2). See also 47
c.r'.n. $ 76.1200.
Affiliated ETC's SAC Affrliated ETC's Name
479026 143051764
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certi/icationformfor each SAC through which it provides Lifeline service).
2019 ID ViaSat Carrier Services lnc.
Recertification Year
N/A
State ETC Name
ViaSat, lnc.
DBA, Marketing, or Other Branding Name
(If same as ETC name, list "N/A" Do not leave blank)
Holding CompanyName
(If same as ETC name, list "N/A" Do not leave blank)
1
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 non-usage requirements. ETCs subject to the non-usage requirertents must indicate the number ofsubscribers 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 E[ No E[
Ifyes, record the number of subscribers de-enrolledfor non-usage by month in Block Q below.
P o
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 byJaws (or
partrership agreernent), 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 Certificatioa, Ail ETCs must 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 enrollment in Lifeline; and/or
B) Confinn consurner 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 offrcer of the company named above. I am authorized to make this certification for the Study Area Code listed
above.
RBInitial
2
Minimum Service Level
I certifu 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.
Initiat RB
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 priorto recertification attemptsC. Tota! number of subscribers ETC is responsible for recertiffing (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of subscnibers verifiod access to a stat€ or federal database.
E. Name of the data sourc{s) used to veri$, consumer eligibility:
ETC Direct ContactF. Subscribers conacted by ETC directly to recertiff (You may also use this section to report subscriber initiated recertifications).
the number ofLifeline subscribers the ETC to obain recertification of
G. Subscribers who failed to recertiff through ETC direct ouheach attempt
the number of Lifeline subscribers de-enrolled due to or to the ETC's outeach
3
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Totrl
A.0 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 0
c.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jut Aug sep Oct Nov Dec Year
Total
0 0 0 0 0 0 0 0D.0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
F 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
G.0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers who recertified throueh ETC direct outreach attempt
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 .dministAto'r third oTUSAC forthe of recertificatim.
J. Name of third party administrator used to veriff subscriber eligibility:
K. Subscribers de-enrolled as a result of a third party recertification attempt
the number ofsubscnlbers as a result or to outreach from a state lhird administraton, or USAC.
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 lhird or USAC
Certification:
Recertification Nlethod: Database
I certifr 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
ftrat
4
Apr MayJanFebMar Jun Jul Aug seP Oct Nov Dec Year
Total
H.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
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 Yesr
Total
K.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jut Aug sep Oct Nov Dec Year
Totrl
L.0 0 0 0 0 0 0 0 0 0 0 0 0
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 thebest ofmy knowledge, the company obtained sigred certifications from 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.
Initial
Recertilication Method: Third Party
I certiff that the company listed above has procedures in place to recertifu consumer eligibility by relying on an
administrator. I am an oflicer of the company named above. I am authorized to make this certification for the SAC(s)
listed above.
Initial
No Subscribers
I certiff 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 RB
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.
Sigrred,
Robert Blair, President and Secretary Robert Blair, President and Secr
Sigrature of Officer
Robert. [e-mail]
Email Ad&ess of Officer
Pemon Completing This C€rtification Form
Printed Name and Title of Officer
Feb27,2020
Date
Contact Phone Number
5
y=14+K)N = (D+F+r)O=M/l.{*lfi)
Total number of subscribers de-enrolled as
a result of recerdfication
Total number of subscribers ETC ts
responsible for recerdfying
Percent of subscribers due for
recerdllcation who were de-enrolled
0 0 0.00/o
Affiliated ETCs
SAC Name
6