20210216Boomerang Wireless Form 555.pdf

Comoliance
Solutions\Ea 7he worldwlde leader oltu and conplianca tarvi@s.
January L7,2021"
Commission Secretary
ldaho Public Utilities Commission
472W. Washington
Boise, lD 83702
RE: Docket No. GNR-T-t7-01- FCC Form 555-Annual Lifeline Certification- Filed on behalf of
Boomerang Wireless, LLC d I b I a enTouch Wireless
Dear Secretary,
Pursuant to FCC requirements under 47 C.F.R. 5 54.416, enclosed please find for filing in the above-
referenced docket a copy of Boomerang Wireless, ILC d/b/a enTouch Wireless' FCC Form 555 - Annual
Lifeline Eligible Telecomm unications Carrier Certification.
lf you have any questions regarding this filing, please contact me at [phone] or
[e-mail].
Res itted
Mark
Attorney-in-Fact
Boomerang Wireless, LLC d/bla enTouch Wireless
Enclosures
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 31st (Annually)
Does the reporting company have affiliated ETCs? Yes @ No @
Provide a list of all ETCs that are aJliliated 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 de/ines "afiiliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common ownership or conlrol with, another person." 47 U.S.C. S 153(2). See also 47
cF.R. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
t
479022 143036595
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Canier (ETC) must provide a certi/icationformfor each SAC throughwhich it provides Lifeline service).
2020 tD N/A
Recertification Year
N/A
State ETC Name
N/A
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do not leave blank)
Holding Company Name
(If 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 collect a monthly fee from their _Lifeline subs_cribers are subject
to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number ofsubscribers de-enrolled by month in
Section 4. ETes that only assess a fee but do not collect such fees 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 EII
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 3
February 1
March 0
April 0
May 0
June 0
July 0
August 0
September 0
October 0
November 0
December 0
Total Subscribers 4
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 Certificatiott Atl 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) 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.
TSInitial
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 attempts
C. Total number of subscribers ETC is responsible for recertifring (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 verifr consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertify (You may also use this section to report subscriber initiated recertifications).
the number of Lifeline subscrihe,rs the ETC to obtain recertification
G. Subscribers who failed to recertify through ETC direct outreach attempt
the number of Lifeline subscribers due to or to the ETC's outreach
3
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov.Dcc 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
Aug sep Oct Nov Dec Year
Total
Jan Feb Mar Apr May Jun Jul
0 0 0 0 0 0 0 0 0F0000
Year
Total
May Jun Jul Aug sep Oct Nov DecJanFebMarApr
0 0 00000000G000
H. Subscribers who recertified through ETC direct outreach attempt
the number ofLifeline subscribers that recertified ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number ofLifeline subscribers contacted a state administrator. third administrator, or USAC for the of recertification.
J. Name of third party administrator used to veri$ 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 administrator or USAC.
L.Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number of subscribers that recertified from a state administrator third administrator or USAC
Certification:
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 officai of the company nanied above. I ani 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
0H.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 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 .Iul Aug sep Oct Nov Dec Year
Total
L.0 0 0 0 0 0 0 0 0 0 0 0 0
M=(G+K)N = (D+F+I)O = M/N*100
Total number ofsubscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent ofsubscribers due for
recertification who were de-enrolled
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 TS
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,
Todd Shores VP of Finance & Accoun Todd Shores VP of Finance & At
Signature of Officer
ts hores@readywi re less. com
Email Address of Officer
lr/ark Lammert
Person Completing This Certification Form
Printed Name and Title of Offrcer
Jan 28,2021
Date
407-794-3488
Contact Phone Number
5
Affiliated ETCs
SAC Name
6