20200604Filer Mutual Telephone Form 555.pdf

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FILERM/UTUAL
Telephone Company
May 22,2O2O
Ms. Diane Hanian
Commission Secretary
Public Utilities Commission of ldaho
472W Washington
Boise, lD 83702
RE: IPUC Docket GNR-T-20-01: Annual Lifeline Certification for Filer Mutual
Telephone Company, lnc. in ldaho
Dear Ms. Hanian,
Filer Mutual Telephone Company, lnc. ("the Company" or "Filei') 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
(D to the FCC and the UniversalService 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 (2OA) 326-4331 if you have any questions.
Sincerely,
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Eufu
Robert Kraut
General Manager
Enclosures
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: Jonuary 31't (Annually)
Does the reporting company have affiliated ETCs? Yes EE No E[
Provide a list of all ETCs that ore affiliated with the reporting ETC, using page 4 ond additional sheets if necessary. Affiliation shall be
determined in accordance with Section 3(2) of the Communications Act. Thot Seclion defines "ffiliate" as "a person that (directly or indirectly)
o\ens or conlrols, is owned or conlrolled by, or is under common ownership or control with, another person." 47 U.S.C. S 153(2). See also 47
c.F.R. $ 76.t200.
Affiliated ETC's SAC Affiliated ETC's Name
472220 14300251 3
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certification form for each SAC through which it provides Lifeline service)
2019 lD Filer MutualTelephone Company
Recertification Year
N/A
State ETC Name
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)
1
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriale check-box. ETCs thal do nol assess and collect a monthlyfeefrom their Lifeline subscribers are subject
to the non-usage requirements. ETCs subject to lhe non-usage requirements must indicale the number ofsubscribers de-enrolled by month in
Section 4. ETCs lhat onll' assess afee bul do not collect suchfees are subjecl lo lhe non-usage requirements and musl also indicate ilrc number of
subscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements? yes E[ No EII
Ifyes, record the number ofsubscribers de-enrolledfor non-usage by month in Block Q below.
P 0
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
May 0
June 0
July 0
August 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
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 Certificatiort All ETCs musr 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) 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.
RKInitial
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 RK
Annual Recertification
Do not leave empty blocks. Ifan ETC has nothing to report in a block, enler 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
the number ofel subscribers verified 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 recertify (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 recerti! through ETC direct outreach attempt
the number of Lifeline subscribers de-enrolled due to inel or to the ETC's outreach
.len Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
A.2 1 0 0 0 0 1 1 5 1 0 3 14
B.0 0 0 0 0 0 0 0 0 1 0 0 1
C.2 1 0 0 0 0 1 1 5 0 0 3 13
Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
Jan Feb Mar
0 0D.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
F 0 0 0 0 0 0 0 0 0 0 0 0 0
Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
Jan Feb Mar
G.0 0 0 0 0 0 0 0 0 0 000
3
H. Subscribers who recertified through ETC direct outreach attempt
of Lifel that recertified ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator. third party adminishator, or USAC
the number of Lifeline subscribers contacted a state administrator- third administrator- or USAC for the of recertification
Name of third party administrator used to veril) subscriber eligibility:
USAC Database
K. Subscribers de-enrolled as a result of a third party recerlification attempt
the number ofsubscribers as a result of inel or to outreach from a state 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 a from a state administrator third administrator 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
MayJanFebMarAp.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.
1 1 0 0 0 0 1 1 5 1 0 3 13
Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
Jan Feb Mar
K.0 0 0 0 0 0 0 0 0 0 1 0 1
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
0 0 0 1 1 5 0 0 3 13L.2 1 0
Recertification Method: ETC
I certif, that the company listed above has procedures in place to recertifo 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
Recertification Method: Third Party
I certifr 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 RK
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 certifu 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 Robert Kraut
Signature of Officer
[e-mail]
Email Address of Officer
Josie Simons
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 30, 2020
Date
208-326-4331
Contact Phone Number
M - (G+K)N = (D+F+r)O = MN*100
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recerti$ing
Percent ofsubscribers due for
recertifi cation who were de-en rolled
1 13 7 .690/o
5
Affiliated ETCs
SAC Name
6