20210315Filer Mutual Telephone Form 555.pdf

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March 12,2021
Ms. Jan Noriyuki
Commission Secretary
Public Utilities Commission of ldaho
11331 W. Chinden Blvd. Building 8, Suite 201-A
Boise, lD 83714
RE: IPUC Docket GNR-T-21-01: Annual Lifeline Certification for Filer Mutual
Telephone Gompany, lnc. in ldaho
Dear Ms. Noriyuki,
Filer Mutual Telephone Company, lnc. ("the Company" or "File/') is submitting the
attached informational filing to the Public Utilities Commission of ldaho ("Commission")
pursuant to pursuant to 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
(0 to the FCC and the UniversalService Administrative Company (USAC). ETCs are also
required to provide the results of their recertification efforts to state commissions and
relevant tribal governments.
Please do not hesitate to call me at (2Og) 326-4331 if you have any questions
Sincerely,
(ifi;,FrlLERnvzruruAL
\ii,.r'lblephoneCompany
fru#
Robert Kraut
General Manager
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 31s (Annually)
Does the reporting company have affiliated ETCs? Yes EiJ No @
Provide a list of all ETCs that are ffiliatedwith the reporting ETC, using page 4 and additional sheets if necessary. Affiliation shall be
determined in accordance with Section j(2) ofthe Communications Act. That Section defines "afriliate" 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.F.R. S 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
1
472220 143002513
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 Filer Mutual Telephone Company
Recertification Year
N/A
State ETC Name
DBA, Marketing, or Other BrandingName
(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
All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthly fee from their Lifeline subs_cribers are s-ubject
to the non-usage ,6quirements. EfCs subject to the non-usage requirements must indicate the number"ofsubscribei's de-enrolled by month ii
Section 4. ETCs that only assess afee but do not collect suchfees 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 Eil No @l
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 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 offrcer 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. tf the filer is a sole proprietorship, the owner must sign the certification.
Initial Certification u nrct must complete this section
I certifr 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 andlor 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.
RSKInitial
2
Annual Recertification
Do not leave empty blocks. Ifan ETC has nothing to report in a bloch 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 recertifying (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of 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).
the number of Lifeline subscribers the ETC contacted to obtain recertification of
G. Subscribers who failed to recertiff through ETC direct outreach attempt
the number of Lifeline subscribers de-enrolled due to or to the ETC's outreach
3
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
A.2 5 0 0 0 0 2 0 0 1 1 3 14
B.0 2 0 0 0 0 0 0 0 0 0 0 2
C.2 3 0 0 0 0 2 0 0 1 1 3 12
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
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
F 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
G 0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers who recertified through ETC direct outreach attempt
the number of Lifeline subscribers that recertified ETC's outreach
Third PartyI. 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.
Name of third party administrator used to verifr subscriber eligibility:
USAC
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of of to outreach from a state administrator third or USAC.
L. Subscribers who recertified through a state administratoq third party administrator, or USAC's recertification effort
the number ofsubscribers that recertified a from a state third administrator, or USAC
Certification:
Recertification Method: Database
I certifu that the company listed above has procedures in place to recertifu consumer eligibility by relying on a database. I
am an officer of the company named above. I am authorizedto 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
H.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
I.2 3 0 0 0 0 2 0 0 1 1 3 12
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
K.0 2 0 0 0 0 0 0 0 0 0 0 2
Jan Mar Apr May JunFeb Jul Aug Sep Oct Nov Dec Year
Total
L.2 1 0 0 0 0 2 0 0 1 1 3 10
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 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 certiff that the company listed above has procedures in place to recertifr consumer eligibility by relying on an
administrator. I am an officer of the company named above. I am authorizedto make this certification for the SAC(s)
listed above.
1n;1;x1 RSK
No Subscribers
I certifr 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
Signature Block
By signing below, I certifr 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 authorizedto make this certification for the Study
Area Code (SAC) listed above.
Signed,
Robert Kraut COO
Signature of Officer
[e-mail]
Email Address of Officer
JOSIE SIMONS
Person Completing This Certification Form
Robert Kraut COO
Printed Name and Title of Officer
Jan 26,2021
Date
208-326-4331
Contact Phone Number
5
M=(c+K)N: (D+F+I)o: M/lr{*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
2 12 16.660/o
Affiliated ETCs
SAC Name
6