20210111Albion Telephone Form 555.pdf

AEC
ommun ications
p 208-673-5335 I t 208-673-6200 / e [e-mail] I a 225 W. North St. Albion, lD 83311
January 06,2O2\
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ldaho Public Utilities Commission
PO Box 83720
Boise, lD 83720-0074
To Whom lt May Concern:
I am filing a copy of my FCC Form 555 which I have also filed with the FCC and USAC. tf you have any
questions or need additional information, please let me know.
Sincerely,
Kyle Bradshaw
Assistant General Manager
Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers must complete all or portionsof all sections Form must be submitted to USAC and filed with the Federal Communications bommissionIMPORTANT: PLBASE READ INSTRUCTIONS FIRST
Deadline: Januury 31u (Annually)
472213 M3A02510
Study Area Code (SAC)
(An Eligible Telecommunications
2020
Service Provider Identification Number (SPIN)
Carrier (ETC) must provide a certification.lbrmfor each SAC through which it provides Lifeline service).
lD Albion Telephone Company lnc.
Recertification Year
N/A
State ETCName
DBA, Marketing, or Other Branding Name
(If same as ETC name, list "N/A" Do rct leave blank)
Holding CompanyName
(If same as ETC name, list "N/A" Do not leave blank)
Does the reporting company have afliliated ETCs? yes EI No @l
Provide a list of all ETCs that are alliliated with the reporting ETC, using page 4 and additional sheets if necessary. Affiliation shall bedetermined in accordance with Sectiotl 3(2) of the Communications Act. That Section defines "alJiliate" as "a person that (dit"ectly or indirectly)oww or controls, is owned or controlled by, or is under common ownership or control iitlr, onitlr", person." 47 U.S.C. $ t 53(2).- See also 47cr.R..f 76.1200.
Affiliated ETC's SAC ETC's Name
7
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 subjectto the non-usage r-equire.ments. ETC^s sybiegt to the non-usage^requireme,nts must indicate the nuriber'of subscrtbeVs de-enrolled by month iiSectiotl 4. ETCs that onlv assess -afee but do not collect suchfees are subject to the non-usage requireients and must also indicatl the number of
subs cribers de- enro I led by mon t h."
Is the ETC subject to the non-usage requirements? Yes @J No @
If yes, record the number o.f subscribers de-enrolled.for 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
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
parhrership 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 olt Ail ETCs nxust conxptete this 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) Confinn 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 authorizedto make this certification for the Study Area Code listed
above.
Initial RR
2
Annual Recertification
Do not leave empty blocks. If 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.
B.
C.
Subscribers eligible for recertification by anniversary month
Subscribers de-enrolled prior to recertification attempts
Total number of subscribers ETC is responsible for recertifying (A-B)
Recertifi cation Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of subscribers verified access to a state or federal database.
E. Name of the data source(s) used to vedfu consumer eligibility:
ETC Direct Contact
F Subscribers contacted by ETC directly to recerti$r (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 recerti8u through ETC direct outreach attempt
the nurrber 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
TotalA.0 4 0 0 1 0 0 1 1 0 1 1 I
B.0 0 0 0 0 0 0 0 0 0 0 0 0
C.0 4 0 0 1 0 0 1 1 0 1 1 I
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
TotalD.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
TotalF0000000000000
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
TotalG.0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers who recertified through ETC direct ouaeach attempt
the number of Lifeline subscribers that recertified ETC's outreach
Third Party
I. Subsclibers whose eligibility was reviewed by state adminishator, third party administrator, or USAC
the number of Lifeline subscribers contacted a state administrator, third or USAC for the of receftification.
J Name of third palty administrator used to verify subscriber eligibility:
USAC
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of ol'to outreach fronr a state admin third administrator or USAC.
L. Subscribers who recertified through a state adminishator, third party administrator, oI USAC's recertification effort
the number of subscribers that recertified a from a state thid administrator, or USAC
Certification:
Recertification Method: Database
I certify that the company listed above has procedures in place to recertifz 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.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 4 0 0 1 0 0 1 1 0 1 1 I
Jan Feb Mar 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 4 0 0 1 0 0 1 1 0 1 1 9
Recertification Method: ETC
I certiSr that the company listed above has procedures in place to recertifu 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
Recertifiication Method: Third Party
I certify that the company listed above has procedures in place to recertiflz consumer eligibility by relying on an
administrator. I am an officer of the company named above. I am authorizedto make this certification for the SAC(s)
listed above.
Initid RR
No Subscribers
I certify that my company did not claim federal low income support for any Lifeline subscdbers for the current Form 555
datayear.I am an officer of the company named above. I am authorizedto rnake 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 authorizedto make this certification for the Study
Area Code (SAC) listed above.
Signed,
RICH REDMAN PRESIDENT RICH REDMAN PRESIDENT
Signature of Officer
[e-mail]
Email Address of Officer
JULIE LAUMB
Person Completing This Certification Form
Printed Name and Title of Officer
Jan A6,2021
Date
208-673-2208
Contact Phone Number
M= (G+K)y = gp+r+I)O = M/II*100
Total number ofsubscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent ofsubscribers due for
recertifi cation who were de-enrolled
0 I 0.0%
5
Affiliated ETCs
SAC Name
6