20210119Direct Communications -Rockland Form 555.pdf

Annud llfellne Hlglble Teleoommunlcadonr Cerrlen Certfrcafun Form All caniers mrt complete dl orportions
of all eectiousFormmrstbo s$mifiodb USAC and ffledwithfteFodsral Comunications Comission
IMPORTAIYTS PLEASE REAI) INSTRUCTIONS FIRST
Dqdlilrc: tranuty 37e (Annuolly)
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Stdy Arca Codo (SAC) Scrvicc hovftler ldcmtiffcdion Number (SPIN)
@nWWTfutsrrsriufrdtseies@rc)Da,ttpwidcawflicfrcnloratfoadtSlCilnougbtthtdrAWiblnfelbr.sie),
2U2O D Dtred Communlcaflons - Rockland lnc.
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StstoRscertificatimYEar
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HoldingCoryoyNano(f tm u HC nm, lbt "NIA" Do trot lav brdk)
DB.f lvla*pting, u Otrer Brandiqg Naoo({ tuu a EIC nau, ltl'MA' h rct law bW
El1Cr Subfeet to the Non-Urage Roqdrcueutr
Au Ercs DutJ, @tt Dlae the omoorlate chd,fu. EICI tlut do nu usarc d ollea a nonthtvlelrottt th* Iffehp ct }orr,ibqs arc flbJd
to tle tlrlnl,yr;ape iautaiair. EICr szlbtcct b tlg ,on-weo ,eotdnarrarg r,llllg,t irdute te rfu-of strhg,lrur dmtrulld by n',,itth iaWon4.Eltttfronlyasasalcehidonotollawlleianabieaudutoturyrqdeiattsqdm6aboildmutluadeotatMbaeqaplldbyDptdL
Ir tho ETC subJcct to the non+rage rcqulremenE? Yes E[ No Ell
{ ye4 rword thc alrlttbcl, $ subsafba daawlld Sr twatsap by nunth h illd Q Movr.
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Month Sr$scribcrs Do,Enrollcd fc Nou-Usaee
Januanr 0
Februrv 0
I\fsm,h 0
Aoril 0
Iv[av 0
Jms 0
Jnlv 0
Aueust 0
Seotc,mba 0
Octobcr 0
November 0
December 0
Total Subsibera 0
Forpurposes ofthis filing anofficcrir u occupmtof aposition ti*alin th artiste ofincorpor*io!, artiolcs of formatiorL
or other similar legal docrment. An officcr is a person who ocarpies a position spcoified in tk coporarc by-laws (or
parruership agre€m€dt), aud would typiodly be president, vioc president for operations, vice presidm for fnmce,
conptnoU€r, trcanrr€r, or a compamble posidon If the flcr is a sole proprietorship, the ocm€r m$t siga the cetification.
Irtfirl Cerdficafion fit EICr nl,rrt agu thk tatbn
I certi$ that the coryany listed abovc bas certitroation procedtues in place to:
A) Review inmme andpmgram-bascd eligibilitydoormeotationpriorto cmollinga consuncriathcLifeline program, and
thag to the bcct of my knowlcdgc, the compaay was presmEd with documootatioo of cach oonsumcr's houschold
incoms and/orpmgram-based cligibilityprior to his chereorollmentin Lifeline; and/c
B) Conffrm consumcr sligibility by relying upon aoesss to I stste database and/or notice of oligibility ftom the state
Lifeline adminisEatorpriorto enrolling a consumerin the Lifeline program"
I am an officcr of tbe conpaoy namsd above. I am arxtorid to rneke this certification forthe Snrdy Arca Code Ustod
above.
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Annurl Recertficadon
Do wt lgtvs cntpty blorilg,. If ot EIC h6 r,otlltt g to twrt h o bld, c,tt.' a zqo.
R€Don lbc runbcr ofl.lfrlinc aubrcribcr duo forrccstifioation byoonh (Jruuary-Doceubcr)
A" Sub$ribcrr digiblc brroortrcatioo by annirrcnary ooofrB. $Srcribcrr doqrclbdFtorto rtccdifictti@ l$eryEC. Totrl arubcr of rub$sib6 Erc ir rcqp@!ftlo br rcocrd&tng (A-B)
Rcccdf,caflon Methods
State of fdsral databarcD. SubscribGrtrclrdEodtpugbETCrcccstotbtoorftdanldatrboebyroaivcnrymath
E" Naoc of thc data rmrc{r) urcd b rrud$ coonroor otigibilit},:
ETCDlrcctConbctF. Sttbccribcrt ootrctcdby SIC dtldlyto rc*rti$ (You mry dlo uro rhir rccdo to ryofi sbmribcridtbdrcccdfcrdu!).
ltlBrc
G. Subaodbcnwto fritodo rtccrdff trurShErc ditootodrcrch rnoopt
Jal Bcb Mar APr May Ju Jul Aog ScP Oct No,IrGc Yoar
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
Jal fcD Mtr Apr May JsE Jrt Aug scp Oct NoY I}Cc Ycsr
Totrl
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan FcE M.r APT Msy Jor Id Aug scp Ocr Nw lhc Yerrfohl
F 0 0 0 0 0 0 0 0 0 0 0 0 0
Jal Fcb Mu Apr Mry Jur Jd Aug Scp ft Nov DCC Ycar
Total
G.0 0 0 0 0 0 o 0 0 0 0 0 0
3
Ju fGD Mrr APr Mry Jun Jd Asg 8cp (H Nov De Ycar
Iotrl
tt 0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subrcribcrr urto rccatfcd OnuS EIC tlittct orEsach attcmpt
mftdPsrtyL Submribsr wtooc oligibilityunr rcvicrrcdby fiE rdninirtsatc, ttfudPafty Edninidml, oTUSAC
thH ttc
J. Nanc ofibird party adofoirrorurod b !rcdry gttbcsibcs.ltgtilit,l
K" &rbgcribq! do-conlhd ar a rcetlt of a thhl prrtyrcccrtifcafiou ffiqt
grrrr$f
L SubccribocwtotraldfiddtronSbarhbrfuinirtnlor,6irdpartyadnidrhnor,ortlSAC'rrmtificalioqcrfbrt
fioma
Cortlicadon:
Recertlficedon llflethod: Dshbasc
I c€rtiry that th€ conpey lietod ebovr has Dsoceduros in place to rcccrtiS consumer eligibi[ty by relying on-a dohbasc. I
8m an officer ofthe confany naned above. I am authorized to mcke this oertificatim fff the SAq$ [sted abovc.
Itritirl
4
Yclr
Totrl
(r.f Nw DecMrrAprlflryJua&l Aug Sq&n rGb
0 00000L0000000
Jal Frb Mrr Apr DIey Jun JEI Aug scp (E Nov Ilo.Yor
Totrl
K 0 0 0 0 0 0 0 0 0 0 0 0 0
Yorr
Totel
8rP od Nr DcchJUIAugJrnFoDM.r Apr Mar
0000000L000000
Recsrttf,cafion Metho& ETC
I c€rti& that &c coryany listsd above har procedures in place b recertifr the continued eligbilrty of all of its ti&litrs
nrbncribers, aod6at, tothobeotofmyknowledge, &e ooryanyobainedoigpod certificatioas tmatlsubscdb€rl afrstilg
to lheir contiming eligibility for Lifeline. I am an oficcr of the coryany namod abovp. I an authodzed to E &B this
cortificatiou for thc SAC(s) listed abovc.
Inlfl.l
Rsccrdfrcedon Method: Itlrd Pffty
I certifrthat the coryany listod above hasproce&nes inplaccto rccertifr oonnucr digibilirybyrclying on u
adninistrator. I am aa officer of the oompaoy named abovc. I m alhorircd to DatG tUis ccrtincatim for Oe SACG)
listcd above.
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NoSubacdben
I ccrtifreat mycoryanydidnotclaim fedcral low incoms supporl forany Lifeline subsuibers forthe srumtForm 555
&ta ycar. I an ur oficer oftho oompuy named abovo. I am ruthorized to ns&o thb ccctification for 60 SAC listod
above.
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By sigpiqg below, I a€rti& tbst ths conpsry listcd above is in coopliaoco wi6 all fedsral Lifeline oertificatiotr
Ptoceems. I am an offcer of tho coryany namcd abovc. I am urthorized b make this oertification fr the Strdy
Arca Codp (SAC) listsd abova
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SignrtmofOffioor Ptfulcd Nanc aad Tttle of OfEccr
EoallAd&rarofO6ca Dto
ContutPhm.mtmbctrPorru Cqtodry ltb Ocrtifcrdo Bqu
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Totrl uubrr of robeqlborr ETC lr
reryodDlc for rcocrttylne
Pcccnt ofuub$rlDcrg duc for
rcoerflffia rto rcm do+orulhd
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SAC fme
270//1 Sbr Teleohone Conrpanv lnc.
&ml RlcoTdeohone Cmpanv
5m758 Direct Comru.rnicdions Cedar Valley
Affllated ETCs
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