20210127ViaSat Carrier Services Form 555.pdf

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January 27,2O2L
ldaho Public Utilities Commission
P.O. Box 83720
Boise, lD 8372O-OO74
r"430 SPRTNG H|LL ROAD, SUrrE 315 | UcleAN, VIRGINIA 22102
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RE: Viasat Carrier Services,lnc. - Case No. GNR-T-21-OL-2021, FCC Form 555 -
Annual Lifeline Eliglble Telecommunlcations Carrier Certification
Dear Staff,
Pursuant to FCC requirements under 47 C.F.R. S 54.416, enclosed please find for a copy of
Viasat Carrier Services, tnc.'s FCC Form 555 -Annual Lifeline Eligible Telecommunications
Carrier Certification. As the filing indicates, the company has not yet begun providing Lifeline
service to ldaho subscribers.
lf you have any questions regarding this filing, please contact me at (703) 7L4-L324 or
[e-mail].
Respectfully Su bmitted,
vuat nha-&
Marsha A. Pokorny
Managing Consultant on behalf of Viasat Carrier Services, lnc.
#
479026 143051764
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certificationformfor each SAC throughwhich it provides Lifeline senice).
2020 ID ViaSat Carrier Services lnc.
Recertification Year
N/A
State ETC Name
ViaSat, lnc.
DBA, Marketing, or Other Branding Name
(If same as ETC name, list "N/A" Do not leave blank)
Holding Company Name
(If same as ETC name, list "N/A" Do rct leave blank)
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
IMPORTAI\T: PLEASE READ INSTRUCTIONS FIRST
Deadline: lanuary 31* (Annually)
Does the reporting company have affiliated ETCs? Yes E[ No @
Provide a list of all ETCs that are afliliatedwith the reporting ETC, using page 4 and additionol sheets if necessary. Afliliation shall be
determined in accordance with Section 3(2) of the Communicalions Act. That Section defines "afiliate" 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.r200.
Affiliated ETC's SAC Affiliated ETC's Name
1
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-bo,x. ETCs that do not assess and collect a monthlyfee from their !'ifeline subscribers are subjecl
to the non-usage riquiremenis. EiCs subject to the non-usage requirements must-indicale the number ofsubscribers de-enrolled by month in
Section 4. ETCs tfuit only assess afee bi do not collect suchfeei are subject to the non-usage requirements and must also indicate the number of
subscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements? Yes E[ No Eil
Ifyes, record the number of subscribers de-enrolledfor non-usage by month in Block Q below.
P a
Month Subscribers De-Enrolled for Non-Usage
Januarv 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 Certificatioll Alt 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 progr,lm-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.
RBInitial
2
Annual Recertification
Do not leave enpty 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-enrolled prior to 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 subscribers verified access to a state or federal database.
E. Name of the data source(s) used to verifr consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifr (You may also use this section to report subscriber initiated recertifications).
ofLifeline subscribers the ETC contacted to
G. Subscribers who failed to recertifr through ETC direct outreach attempt
the number oflifeline subscribers de-enrolled due to to the ETC's outeach
3
Jan Feb Mer Apr May Jun Jul Aug sep Oct Nov Dec Year
Totnl
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 Ilec Year
Total
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug S"p 0ct Nov Dec Year
Totel
F 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug sep 0ct 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 subscribers that
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number oflifeline subscribers contacted a state third administrator or USAC for the of recertification.
J. Name of third party adminishator used to verifr subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertification affempt
the number ofsubscribers as a result of or to outreach from a state third administrator orUSAC.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number ofsubscribers that recertified from a state ttrid adminisfrator oTUSAC
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
Oct Nov Dec Year
Total
Mer Apr May Jun Jul Aug sepJanFeb
0 0 0 0 0H.0 0 0 0 0 000
Jan Feb Mer Apr May Jun Jul Aug sep Oct Nov Dec Year
Totel
I.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mer Apr Mey Jun Jul Aug scp 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
Totel
L.0 0 0 0 0 0 0 0 0 0 0 0 0
Recertification Method: ETC
I certiff that the company listed above has procedures in place to recertiff 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 authorizsdto make this
certification for the SAC(s) listed above.
Initial
Recertification Method: Third Party
I certiff that the company listed above has procedures in place to recertiff 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
No Subscribers
I certiff 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 RB
Signature Block
By signing below, I certiff 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 Blair.President and Secretary Robert Blair, President and Secr
Signature of Officer
[e-mail]
Email Address of Officer
Robert Blair
Person Completing This Certification Fonn
Printed Name and Title of Officer
Jan 15,2021
Date
7204936110
Contact Phone Number
M=(c+K)N = (D+F+r)O = M/1\*100
Total number ofsubscribers de-enrolled as
a result of recertificetion
Total number of subscribers ETC is
responsible for recertifying
Percent ofsubscribers due for
recertification who were de-enrolled
0 0 0.0%
5
Affiliated ETCs
SAC Name
6