20210119Rural Telephone Company Form 555.pdf

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RURAL TELECOM AgP W. Madlson Ave., trlenns Ferru, lD A3Ee3
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G,Ut-]t-- )-t'' o t
ldaho PUC
11331 W Chinden Blvd
Building 8 Ste 201-A
Boise lD 837L4
January L8,2021-
Dear ldaho PUC:
Filing copy of FCC 555 form for informational purposes. Our counties include Elmore, Lemhi and
Owyhee.
Sincerely,
Theresa Wilson, Billing Manager
RTlTelephone Company
892 W Madison Ave
Glenns Ferry lD 83623
208-366-26L4
[e-mail]
Annual Lifeline Eligible Telecommunications Carrier Certilication Form All carriers must complete all orportions
of all sections Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS F'IRST
Deadline: Janaary 31,r (Annually)
lL- T- 2t-o r
Does the reporting company have afllllated ETCs? Yes EI No E[
Provide a tist of all ETCr that are afliliated with the reporting ETC, asing page 4 and additioml sheets d necessary. Afliliation shall be
determined in occordance with Seitton 3(2) ofthe Contnrunications Act. That Section defines "atfiliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under connnon ownership or control with, another person," 47 U.S'C, S I 5i(2). See also 47
c.r.R. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
t
Study fuea Code (SAC) Service Provider Identification Number (SPD.I)
(An Etigtbte Telecommunications Carrier @TC) nust provide a certilicatlonlornt for eoch SAC through which it provldes Lifeline semice).
2020 tD RuralTelephone CompanY
472233 143002523
State ETCName
RURAL TELEPHONE COMPANY
Recertification Year
NIA
Holding CompanyName
(If same as EIC nanre, list "N/A" Do not leaw blank)
DBA, Marketing, or Other Branding Name
(lf same os ETC name, list "N/A" Do not leave blank)
ETCs Subject to the Non-Usage Requirements
All ETCs tnust comDlete the.ap-plo!:iate:!-1?l:b?,1: lrct thot do not assess and colle.c! a m.onthlyfefrgm their_Ldetine subs.c.ribets are subject
?^*:^:":-yt:X: riq.uire,me_nts. ETC-s subiect to the non-usage^requiremeni inisii;ii;trii;;;:;;;"iiiiiiirioeo de-enroyed by ntonth insection 4. ETCs that onlv assess afee bul do not collect suchfeei are sttbject to the non-usage requireients and must also iiaiio-i m'iiiirit"r rys ubscribers de-enrol led by mon th.-
Is the ETC subject to the non-usage requirements? yes E[ No E[
If yes, record the number of subsuibers de-enrolled for nonqsage by month in Block e below.
P o
Month Subscribers De-Enrolled for Non-Usage
January 0
Febnrary 0
March 0
April 0
Mav 0
June 0
July 0
August 0
September 0
October 0
November 0
December 0
Total Subscribers 0
For purposes of this filing, an offtcer is an occupant of a position listed in the article of incorporation, articles of forrration,or other similar legal document. An officer is a person who occupies a position specifiei in the corporate byJaws (orpartnership agreement), and would typically be president, vice president for operations, vice president for finance,comptroller, feasurer, or a comparable position. If the filer is a sole proprietorship, the owner mustlign the certification.
Initial Cerfficatiott All ETCs nrust cor,tplete this section
I certifr 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, andthat, to the best of my knowledge, the company was presented with documentation of each "onsrmerl, household
income and/or program-based eligibility prior to his or her enrollment in Lifeline; and/or
B) Confrrm 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.
MMInitial
2
Annual Recertificatlon
Do not leave empty blocks. Ifan ETC has nothing to reporl in a block, eilter a zero.
Report the number of Lifeline subscribers due for recertification by month (January-December)
A. Subscribers eligible for recertification by anniversary month
B. Subscribers de'enrolled prior to recertification attempts
C. Total number of subscribers ETC is responsible for recerti$ing (A'B)
Recertlflcadon Methods
State of federal databasen. Subsqibers recertified through ETC access to state or federal database by anniversary month
the to a state or
E. Name of the data source(s) used to veriff consumer eligibility:
ETC Dlrect Contact this section to report subsuiber initiated recertifications)'F. Subscribers contacted by ETC directlyto recertiff (You mayalso use
the number of Ufeline subscribers the contacted to obtain of
G. Subscribers who failed to recertiry through ETC direct outreach attempt
the number of Lifelinc to ot to the
3
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
A.0 0 0 0 0 0 0 0 0 0 0 0 0
B.0 0 0 0 0 0 0 0 0 0 0 0 0
c.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mer Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
F 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun ,Iul Aug sep Oct Nov Dec Year
Total
G,0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers who recertified through ETC direct outreach attempt
the number recertified ETC'S
Third PartyI. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the numba ofLifcline subccribers contacted a statc administrator third or USAC for the ofrecertification.
J. Name of third party administrator used to veri$ subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertificatiof, attempt
the number ofsubscribers as a rcsult or to oulrcach from a state third or USAC.
L. Subscribers who recertified through a state administrator, third party adminishator, or USAC's recertification effort
the number ofsubscribers that recertilied from a state adminishator third administntor or USAC
Certi{ication:
Recertilication Method: Database
I certifu 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 MM
4
Jan Feb Mar Apr May Jun Jul Aug sep 0ct Nov Dec Year
Total
H.0 0 0 0 0 0 0 0 0 0 0 0 0
Jen Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
TotaI
I.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan tr'eb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
TotaI
K.0 0 0 0 0 0 0 0 0 0 0 0 0
.Ian Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
L.0 0 0 0 0 0 0 0 0 0 0 0 0
14-1c+K)N = GlrF+I)O - lWN*100
Totel number of rubscrtbers de-enrolled as
r rerult of recertlficrtlon
Total number of eubscrlbers ETC ts
responllble for recertlflng
Percent ofsubscrlbere due for
recertlflcetion who rvere de'cnrolled
0 0 0.0%
Recertification Method: ETC
I certifi that the company listed above has procedures in place to recertiff the continued eligibility of all of its Lifeline
subscri-bers, and that, io the best of my knowGdge, the company obtained signed certifications from all subscribers attesting
to their continuing eligibility for Liieline. I am an officer of the company named above. I am authorized to make this
certification for the SAC(s) listed above.
Initial
Recertilication Method: Third Party
I certiS that the company listed above has procedures in place to recertify consumer eligibility by relying on an
adminiitrator. I am an offrcer of the company named above. I am authorized to make this certification for the SAC(s)
listed above.
Initial
No Subscrlbers
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 officei of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial
Signature Block
By sigrring below,I certi$ 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,
Mark R. Martell.
Signature of Officer
[e-mail]
Email Address of Officer
THERESA WILSON
Person Completing This Certification Form
Mane Mark R. Martell, Administrative tt
PrintedNome and Title of Officer
Jan 19 2021
Date
208-366-2614
Contact Phone Number
5
Affiliated ETCs
SAC Name
6