20210201Citizens Telecomm Form 555.pdf

Ziply Fiber
4155 SW Cedar Hills Blvd, Beaverton, OR 97005 Jessica Epley
M. (503) 431-U58
[e-mail]
January 28,2021
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Ms. Diane Hanian
Commission Secretary
ldaho Public Utilities Commission
47 2 W est Washington Street
Boise, ldaho 83720
RE: Docket No. GNR-T-21-01 Annual Eligibility Re-Certification of Lifeline Subscribers
Dear Ms. Hanian:
Citizens Telecommunications Company gf lgrLq dbaZtpty Fiber (Study Area Code 474421) andFrontier Communications Northwest, LLCdbc ziply Fib6rlStudy Area boOe 422i16) herebyqp-vide a copy of its Annual Lifeline Eligible Telecommunications Carrier Certification FCC Form?!! !n compliance with 47 CFR 54.416 as adopted by the Federat Communication Commission(Fcc) in its Lifeline Reform order, Fcc 12-11, releaied February 6,2012.
Section 54.4 16(b) requires eligible telecommunication carriers (ETCs) to annually provide theresults of their re- certification efforts performed pursuant to Section 54.4 10 tO io tne FCC andthe Universal Service Administrative Company (USAC). ETCs are also requireO to provide theresults of their re-certification efforts to state commissions and relevant kibal governments.
Questions reggrding thig filing may be directed to me via email at [e-mail] ortelephone at [phone].
Sincerely,
W
Jessica Epley
Government & External Affairs Director
Annual f,ifeline 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'CommissionIMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 3l,t (Annually)
Does the reporting company have alfiliated ETCs? yes E[ No E[
Provide a list of all ETCs that are afiliated with the reporting ETC, using page 4 and additional sheets if necessary. Afiliation shall bedetermined in accordance with Section j(2) of the Communications Act. That Section de/ines "afiliate"'as "a person that (directly or indirectly)ov)ns or controls, is owned or controlled by, or is under common ownership or control with, orilhil p"rron.,, 47 U.S.C. $ I 53(2).- See also 47c.r.R. $ 76.1200.
Affiliated ETC's SAC ETC's Name
L
474427 143002528
Study Area Code (SAC)
(An Eligib le Telecommunications
Service Provider Identification Number (SpIIrI)
Canier @TC) must provide a certificationformfor each SAC through which it provides Lifeline service).
2020 ID CITIZENS TELECOMM CO OF IDAHO
Recertification Year
N/A
State ETCName
Frontier Communications Corporation
DBA, Marketing, or Other Branding Name
(If same as ETC name, list "N/A" Do not leave blank)
Holding CompanyName
(If same as ETC name, list'N/A' Do not leave blank)
ETCs Subject to the Non-Usage Requirements
Ail ETCs must complete the appropriate check-bgx. ETCs that do not assess and collect a mgnthly{eefrgm their Lifeline subscribers are subiect
to the non-usage requirements. ETCs sybjegr n the nonliii{iiiqiiii^iitt .u*.indiioie ih" ,uiibriot tubscibers de-enrolled bv month in
section 4. ETCs thar onty ,;'ti,,i ;J;"-i;i ii iri "itt""t i;fii;;;;; t;ij*t n the iii-usage requireients and must also indicate the number of
subscribers de-enrolled by month.
Is the ETC subiect 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 a
Month Subscribers De-Enrolled for
January 0
February 0
March 0
April 0
Mav 0
June 0
July 0
Auzust 0
Septernber 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,
o, o1rr"i similar legal document. An oflicer is a person who occupies a position specified in the corporate byJaws (or
partnership agreement), 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 sigr the certification'
Initial Certificatiol Att ETCs must complete this section
I certifu 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 myLowledge, 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; atdlot
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.
Initial BES
2
Annual Recertification
Do not leave empty blocks. Ifan 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 recertiffing (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or lideral database by anniversary month
the number of subscribers verified to a state or federal
E. Name of the data source(s) used to verifi consumer eligibility:
ETC Direct Contact
F Subscribers contacted by ETC directly to recertifu (You may also use this section to report subscriber initiated recertifications).
number of Lifeline the ETC contacted recertification of
G. Subscribers who failed to recertifr through ETC direct outreach attempt
number of Lifeline de-enrolled due to to the outreach
3
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
TotalA.0 0 0 0 0 0 0 0 0 0 0 0 0B.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
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
TotaIF.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
TotalG0000000000000
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
H. Subscribers who recertified through ETC direct outreach attempt
the Lifeline ETC'S
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator' or USAC
the number of Lifeline subscribers contacted a state administrator, third or USAC for the 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 ofsubscribers as a result or to outreach from a state ftird or USAC.
L.Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number of subscribers that recertified a from a state third or USAC
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 authoriied 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
I.0 0 0 0 0 0 0 0 0 0 0 0 0
Dec Year
Total
Oct NovAugsepJunJUIAprMayFebMarJan
000000000000K.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 certify that the company listed above has procedures in place to recerti$ 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 recertifu consumer eligibility by relying on an
administrator. I am an officer of the company named above. I am authorized to make this certification foi the SAC(s)
listed above.
Initial
No Subscribers
I certifr that my company did not claim federal low income support for any Lifeline subscribers for the current Form 555
data year. I am an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
1ni1is1 BES
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.
Signed,
Bvron E.Snrinser-Jr Byron E. Sprinoer,Jr
Signature of Offrcer
[e-mail]
Email Address of Officer
Jessica Epley
Person Completing This Certification Form
Printed Name and Title of Offrcer
Jan 29,2021
Date
5034310458
Contact Phone Number
5
y=14+K)11 = 1tr+F+r)O = M/I\l*lfi)
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertiflng
Percent of subscribers due for
recertification who were de-enrolled
0 0 0.0o/o
SAC Name
472416 Frontier Communications Northwest lnc.
532416 Frontier Communications Northwest lnc
522416 Frontier Communications Northwest lnc.
522449 Frontier Communications Northwest lnc.
484322 CITIZENS TELECOMM CO OF MONTANA
533401 CITIZENS TELECOMM CO OF OREGON
Affiliated ETCs
6