20210201Frontier Communications Form 555.pdf

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Ziply Fiber
4155 SW Cedar Hills Blvd, Beaverton, OR 97005 Jessica Epley
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[e-mail]
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January 28,2021
Ms. Diane Hanian
Commission Secretary
ldaho Public Utilities Commission
472 West Washington Street
Boise, ldaho 83720
RE: Docket No. GNR-T-21-01Annua! Eligibility Re-Certification of Lifeline Subscribers
Dear Ms. Hanian:
Citizens Telecommunications Company of ldaho dbaZiply Fiber (Study Area Code 474427) and
Frontier Communications Northwest, LLC dba Ziply Fiber (Study Area Code 472416) hereby
provide a copy of its Annua! Lifeline Eligible Telecommunications Carrier Certification FCC Form
555 in compliance with 47 CFR 54.416 as adopted by the Federal Communication Commission
(FCC) in its Lifeline Reform Order, FCC 12-11, released February 6,2012.
Section 54.4 16(b) requires eligible telecommunication carriers (ETCs) to annually provide the
results of their re- certification efforts performed pursuant to Section 54.4 10 (f) to the FCC and
the Universal Service Administrative Company (USAC). ETCs are also required to provide the
results of their re-certification efforts to state commissions and relevant tribal governments.
Questions regarding this filing may be directed to me via email at [e-mail] or
telephone at [phone].
Sincerely,
W
Jessica Epley
Government & External Affairs Director
Annual Lifeline Eligibte 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
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 31't (Annually)
Does the reporting company have afliliated ETCs? Yes @ 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 be
determined in accordance with Section 3(2) ofthe Communications Act. That Section defines "afiiliate" 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 I 5i(2). See also 47
c.r.n. s 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
1
472416 143004786
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certificationformfor each SAC through which it provides Lifeline service).
2020 ID Frontier Communications Northwest I nc.
Recertification Year
N/A
State ETCName
Frontier Communications Corporation
DBA, Marketing, or Other BrandingName
(If same as ETC rwme, list "N/A" Do not leave bhnk)
Holding CompanyName
(If same as ETC name, list "N/A" Do rat leave blank)
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthlyfeefrom their Lifeline subscribers are subject
to the non-usage requirements. 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 rubject 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 E[
Ifyes, record the number ofsubscribers de-enrolledfor non-usage by month in Block Q below.
P o
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
May 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,
or other similar legal document. An officer 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 filer is a sole proprietorship, the owner must sign the certification.
Initial Certificatiol. All ETCs nust complete this section
I certi$ 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) 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 offrcer of the company named above. I am authorized to make this certification for the Study Area Code listed
above.
BESInitial
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 federal database by anniversary month
the number of subscnbers 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 recertifr (You may also use this section to report subscriber initiated recertifications).
the number of Lifeline subscribers
G. Subscribers who failed to recertifr through ETC direct outreach attempt
the number ofLifeline subscribers
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 0000
Jan Feb Mar Apr May Jun Jul Aug sep 0ct Nov Dec Year
Total
0 0F00000000000
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
L Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number of Lifeline subscribers contacted a state third or USAC for the ofrecertification.
J. Name of thi.d 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 of or to outreach from a state thild orUSAC.
L. Subscribers who recertified through a state adminishator, third party administrator, or USAC's recertification effort
the number of subscribers that recertified a from a state lhird oTUSAC
Certification:
Recertilication 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 oflicer 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 JUI Aug sep Oct Nov I)ec Year
Total
H.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
I.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
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 certify that the company listed above has procedures in place to recertifr 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 offrcer 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 recertify 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 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 offtcer of the company named above. I am authorized to make this certification for the SAC listed
above.
1ni6s1 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,
Byron E. Springer, Jr Byron E. Springer, Jr
Signature of Officer
[e-mail]
Email Address of Officer
Jessica Epley
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 29,2021
Date
5034310458
Contact Phone Number
5
14 = (G+K)N = (D+F+r)O = M/ll*lfi)
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent of subscribers due for
recertification who were de-enrolled
0 0 0.0o/o
SAC Name
532416 Frontier Communications Northwest lnc.
522416 Frontier Communications Northwest lnc.
522449 Frontier Communications Northwest lnc.
474427 CITIZENS TELECOMM CO OF IDAHO
484322 CITIZENS TELECOMM CO OF MONTANA
533401 CITIZENS TELECOMM CO OF OREGON
Affiliated ETCs
5