20210201TracFone Wireless Form 555.pdf

TRACF@NE*
wireless, inc.
,,,. ; II* * i FH 2' *S
January 29,2021
VIA OYERNIGHT MAIL
Jean Jewell, Secretary
Idaho Public Utilities Commission
472W. Washington St.
Boise,ID 83720
Re: TracFone Wireless, Inc. - FCC Form 555 Report
Dear Ms. Jewell
In accordance with the Federal Communication Commission's Lifeline Reform Order
and 47 CFR 54.416(b) please find enclosed a copy of the FCC Form 555 Report of TracFone
Wireless Inc. ("TracFone"). You may reach me at [phone] or sathanson@.tracfone.com if
you have any questions.
Sincerely,
tu
Stephen Athanson
Regulatory Counsel
www.tracfone.com lwww.netl0.com lwww.straighttalk.com lwww.safelink.com
!
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
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 3lst (Annually)
Does the reporting company have affiliated ETCs? Yes E[ No E[
Provide a list of all ETCs that are affiliated with the reporting ETC, using page I and additiorul sheets if necessary. ffiliation shall be
determined in accordance with Section 3(2) of the Communications Act. That Section de/ines "ffiliate" 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
t
479021 1430301 03
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certificationformfor each SAC throughwhich it provides Lifeline service).
2020 ID TracFone Wireless lnc
Recertification Year
SafeLink Wireless
State ETC Name
TracFone Wireless lnc
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do not leave blank)
Holding Company Name
(lf same as ETC name, list "N/A" Do not leave blank)
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do not assess and colle.ct a monthly fee from their .Lifeline subs.cribers are subiect
to the non-usage rdquiremenis. EfCs subject to the non-usage -requirements must-indicate the number of subscribers de-enrolled by month in
Section 4. iiit tluit onty assess a fee bui 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 @ No @
Ifyes, record the number ofsubscribers de-enrolledfor non-usage by month in Block Q below.
P a
Month Subscribers De-Enrolled for Non-Usage
January 12
February 14
March 13
April 0
Mav 0
June 0
July 0
Aus,ust 0
September 0
October 0
November 0
December 0
Total Subscribers 39
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 Certificatiotl All ETCs nust 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) 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 JR
2
Annual Recertification
Do not leave empty blocks. Ifan ETC has nothingto 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 month
B. Subscribers de-enrolled priorto recertification attempts
C. Total number of subscribers ETC is responsible for recertifuing (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of verified access to a state or federal database.
E. Name of the data source(s) used to verify consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertil! (You may also use this section to report subscriber initiated recertifications).
the number of Lifeline ETC contacted to obtain recertification of
G. Subscribers who failed to recertifu through ETC direct outreach attempt
the number of Lifeline due to or to the ETC'S outreach
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
Dec Year
Total
May Jun Jul Aug sep Oct NovJanFebMarApr
0 0 0 0 0000000D00
Year
Total
May Jun .Iul Aug Sep Oct Nov DecJanFebMarApr
0 0 00000000F000
Year
Total
Jun Jul Aug sep 0ct Nov DecJanFebMarAprMay
0 0000000G.0 0 0 0 0
H. Subscribers who recertified through ETC direct outreach attempt
that
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 of recertification.
J. Name of third party administrator used to verifr subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of or to outreach from a state administrator third adm or IJSAC.
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 administrator third administrator or USAC
Certification:
Recertifi cation 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
Aug sep Oct Nov Dec Year
Total
Mar Apr May Jun JulJanFeb
0 0 0 0 0 000000H.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
Oct Nov Dec Year
Total
Apr May Jun Jul Aug sepJanFebMar
0000000K.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 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 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 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.
Signed,
Javier Rosado. Sr. Officer Alternative Javier Rosado, Sr. Officer Altern
Signature of Offrcer
[e-mail]
Email Address of Officer
Janet Morejon
Person Completing This Certification Form
Printed Name.and Title of Officer
Jan 28,2021
Date
3057156522
Contact Phone Number
M=(G+K)N: (D+F+I)o = M/l.r[*100
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifu ing
Percent ofsubscribers due for
recertifi cation who were de-enrolled
0 0 0.0%
5
Affiliated ETCs
SAC Name
5