HomeMy WebLinkAbout20210127Farmers Mutual Telephone Form 555.pdfMOSSADAMS
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T (5O9) 747-2600
F (509) 624-5129
6O1 W. Riverside Avenue
suite 1800
Spokans, WA 99201
VIA EMAIL: secretarv@puc.idaho.oov
January 27,2021
ldaho Public Utilities Commission
Jan Norijuki
Commission Secretary
11331 W. Chinden Blvd., Bldg.8
Suite 201-A
Boise, lD 83720-0070
Re: Case No. GNR-T-21-01 ln the Matter of the 2021 Lifeline - FCC Form 555 Filing
Dear Ms. Norijuki:
Attached for filing in accordance with the above referenced proceeding is a copy of the Form 555 for
Farmers Mutua! Telephone Company (SAC 4722211.
An electronic version of the filing was also submitted via the FCC's website on January 27,2021.
lf you have any questions or concerns about this Certification, please contact me.
Sincerely,
/,rru-
Tym Rutkourskl
Senior Manager
l5o9)777-0137
tvm. rutkowski@ mossadams. com
Attachment
472221 143002514
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Canier (ETC) must provide a certificationformfor each SAC through which it provides Lifeline service).
2020 ID Farmers Mutual Telephone Company
Recertification Year
N/A
State ETCName
DBA, Marketing, or Other Branding Name
(If same as ETC name, list "N/A" Do wt leave blank)
Holding CompanyName
(If same as ETC name, list "N/A" Do rct leave blank)
Annual Lifeline Etigible Telecommunications Carrier Certilication Form All carriers must complete all or portions
of all sections Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTAIIT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 31r" (Annually)
Does the reporting company have afliliated ETCs? Yes E No E[
Provide a list of all ETCs that are ffiliated with the reporting ETC, using page 4 and additional sheets if necessary. Affliation shall be
determined in accordance with Section 3(2) of the Communications Act. That Section delines "affliale" 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 153(2). See also 47
c.r.R. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
1
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the approprtate check-box. ETCs that do not assess and collect a rnonthlyfeefron their Lifeline subscibers are subject
to the non-usage requiranents. ETCs subject to the non-usage requirements must indicate the number of subscribers de-enrolled by month in
Section 4. ETCs that only assess afee but do not collect suchfees are subject to the non-usage requirernents 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-Usase
January 0
February 0
March 0
April 0
Mav 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 oflicer is a person who occupies a position specified in the corporate byJaws (or
partnership agreernent), and would typically be president, vice president for operations, vice president for finance,
comptroller, treasurer, or a comparable position. If the frler is a sole proprietorship, the owner must sigrr the certification.
Initial Certificatiol. All 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) Confrm 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.
DEGInitial
2
Annual Recertification
Do not leave empty bloclcs. 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. Subscribers eligible for recertification by anniversary monthB. Subscribers de-enrolledpriorto recertification attemptsC. Total number of subscribers ETC is responsible for recerti$ing (A-B)
Recertification 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 veriff consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertift (You may also use this section to report subscriber initiated recertifications).
the number ofLifeline subscribers the ETC of
G. Subscribers who failed to recertifu through ETC direct outreach attempt
the number of Lifeline to the ETC's oufeach
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 Mar Apr May Jun JUI 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 through ETC direct outreach attempt
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number ofLifeline subscribers contacted a state .dministrator rhtud oTUSAC forthe ofrecertification.
J. Name of third party administrator used to verifu subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of ol to outrreach from a state administrator, third orUSAC.
L. Subscribers who recertilied through a state administrator, third party administrator, or USAC's recertification effort
the number of subscribers ftat recertified a from a state third oTUSAC
Certilication:
Recertification Method: Database
I certiff that the company listed above has procedures in place to recertify 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 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
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 0 0 0 0 0 0 0 0 0 0 0 0
Recertification Method: ETC
I certi$ that the company listed above has procedures in place to recertify 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 certify that the company listed above has procedures in place to recertifr 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 certify that my company did not claim federal low income support for any Lifeline subscribers for the current Form 555
datayear.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 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 authorized to make this certification for the Study
Area Code (SAC) listed above.
Sigrred,
Daniel Greig General Manager DanielGreig General Managt
Signature of Officer
dan@fmtc.com
Email Address of Officer
Krista Byrd
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 25,2021
Date
2084522000
Contact Phone Number
M=(G+K)11 = @+F+I)O = M/l\tlfi)
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifylng
Percent of subscribers due for
recertilication who were de-enrolled
0 0 0.0%
5
Affiliated ETCs
SAC Name
6