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Home My WebLink About20220110Rural Telephone Company Form 555.pdfal?TI-${rc ilvaD EURAL TEL€COM aga W. fvirdbsr A\ra, OlGrmt FGrrl,L lO E3Eaa tilirl-iJ f UilLIC ,,.r T : L I T { [,5 f, Cl,4M ls sloFl ldaho PUC 11331WChlnden Bfud Bulldlng 8 Ste20l-A MselD 837L4 January tO,2O22 Dear ldaho PUC: Flllng copy of FCC 555 form for lnformatlonal purposes. Our countles lnclude Elmore, Lemhl and Oryhee. Slnoerely, Theresa Wkon, Bllllng Manager RTI Telephone @mpany 892W Madlson Ave Glenns Ferry lD 83623 2(ts-365-2614 Theresa.wllson@ruraltel.ors Annual Llfellne Ellglble Telecommunlcatlons Carrler Certlllcaflon Form Al[ canters must comploto all orportions of all sections Form must be submitted to USAC and filed with the Federal Communications Commission IMPORTAI{T: PLEASE READ INSTRUCTIONS F'IRST Detdllne: Jonuary SIn (Annually) Doer the rcportlng compony havo afllllated ETCs? Yes @ No E[ Provlde o lisl of all EI?.s tha orc afliliated with the rcporttng EIC, uslng pge 4 ond addilional sheeu ifneccssary, lffiltatton shall be detentined in accordance wfih Section jQ) olthe Connunlqtlons Act, Thqt Secilon ddines "f,filiate' os "a pet'son that (dircaly or lndtrcctly) otws or cont ols, ls ovnd or anlrolled by, or ls undq coumon orwershlp or conhol wllh, onolher person." 47 U.S,C. i 153(2). See also 47 c.F.fi. s 76,1200. Affiliated ETC's SAC Affiliated EIC's Name 472233 143002523 Study Area Code (SAC) Service Provider IdentificationNumber (SPhI) (An Ehglble Telxommanlstlons Carrter (ETC) must provlde a certltlcatton form fo' arch SAC througlt whidt it proddes ltlellne servte), 2021 ID Rural Telephone Company Recertifioation Year N/A State ETCName RURAL TELEPHONE COMPANY DBA, Ma*eting or Other Branding Name Qf sane os EIV aame, lltl "N/A" Do plleaw blank) Holding CompanyName 1 ETCs Subject to the Non-Usnge Requlrements All EtCs ml,st unflete lhe appmprta@ check-bo-x. ETCs iln, do nol assess and collecl o nonlhlyleefion thetr Lllellne subsotban arc subJect lo lhe non-usage rcqulranranls. ETCs subJea b fien_ontoage-requiremants must lndlste the number otsuhtwlbers d*enrolled by mouth ln Sectlon 4. EI1Js thal only assas a fee but do nol collect such fees arc subJecl lo ihe non-usage rquhements and mu$ alw lndtmtb the nunber ot suhsa'lben de-enrclled by month, Is the ETC rubJect to the non-ulage requlrements? yes E[ No E[ Ifyes, rccnr<l the number olsuhtulberx de-enrolledfor non-usoge by month tn Bloc* Q below. P o Mon0r Subsoribers De-Enrolled for Non-Usaso January 0 Febnrary 0 March 0 April 0 Mav 0 June 0 July 0 Aupust 0 September 0 October 0 Novernber 0 December 0 Total Subscribers 0 For purposes of this filing an ofticer ie an ocoupant of a position listed in the article of incorporation, articles of formation, or other similar legal dooument. An officer is a person who occupies a position speoified in the corporate byJaws (or partnerchip agreement), and would typically be president, vice prrsident for operations, vice prrsident for finance, comptroller, fre&surer, or a comparable position, If the filer is a sole proprietorship, the owror must sig;n the certification. Initial Certification, tlil Er:c;c musi cotnplete thts seaton I certi$ that the company listed abovo has certification procedures in place to A) Review income and progam-based eligibility documentation prior to enrolling a consumer in the Lifeline prograrn, and that, to the best of my knowledge, tho company was presented with documentation of each consumer'B household income and/or program-based eligibility prior to his or her enrollment in Lifeline; and/or B) Confirm consurner 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 tha Lifeline program. I am an officer of the oompany named above. I am authorized to make this certification for tho Study Area Code Iisted above. MMInltinl 2 Annunl Recerfiflcation Do not leove empty blocks. If an ETC har nothing to reporl ln a blo*, entet o zeto, Report thc number of Lifeline subscribers due for recrtificalion by moath (Jaluary-December) A. Subscribsrs cligiblo fur rccortification by anniveraary monlhB. Subscribers de-enrolled pior to reccrlification attcrnplsC, Total number of gubsoriborr BTC is rasponsible for rccerti$ing (A-B) Recertlflcadon Methoils State of federal databeceD. Subscribqr rcccrtiftcd through BTC accc.ss to stat€ or federal database by anniversary rnonth suMbasvcrificd acccsg to a strtc tr fedcral datrbosc. E. Namo of the data eource(s) ueed to verify oonsumer eligibility ETC Dlrect ContactF. Subscribers contacted byETC directly to recerti$ (You may also use lhis section to report subsorlberinitiatedrecertiffcations), &o numberof bobtaln G. Subscribcrs who failed to recerlify through BfC dircot ouhcaoh attempt thc numbcr of Llfolino rubscrlbore ds+orollcd drc to to thoETC's outncrc,h lhc 3 Jru Feb Mar Apr May Jun Jul Aug sop Oct Nov Ilec 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 Jrn Feb Mrr Apr May Jun Jul Aug seP Oct Nov Dec Year Totnl 0 0 0 0 0 0 0 0 0 0 0D.0 0 Jan Fob Mar Apr May Jun Jul Aug sep Oct Nov Dec Yem Totd F.0 0 0 0 0 0 0 0 0 0 0 0 0 Jrn Fob Mer APr Mey Jun Jul Aue sep Oct Nov Dec Yerr Totd o.0 0 0 0 0 0 0 0 0 0 0 0 0 H. Subscribcn who roccrtiffed lhrougb ETC dircct ortrcach *ternpt Thlrd PartyI. Subscribers whoso eligibility was rcvicrrued by stato administrator, third party adminishrtor, or USAC tbs numbcr oflifcllnc rubsoribers cotrtoctsd s Bl|to 6ird ortiSAC for tho ofrcocrliliortion, J. Namo of tlrird party adminisrator used to veri$ subscriber eligibility: K Subscribcrs dc-cnrollcd as a result of a third party recertification atlcmpt ttc numbcr ofsubscdbcrs as a rcsult Or to outrcach ftom r slate thid orUSAC, L. Subscribora who rccertlffed lhrough a $ale administmtor, thirdparty admiuistrntor, or USAC's r€certification ofhrt tho nunbor of rubsoribcn that reccr{ifod from a slrlo &id oTUSAC Certlffcatlon: Recertlflcatlon Method: Datrbase I certifl that the comp&ny listed above has procedures in place to recertify consumer eligibility by relying on a databaso. I am an officor of the oompany named above. I am authorized to make this certification for the SAC(s) listed above. Inltlal 4 Ilec Yerr Tolnl Jan Feb Mnr Apr Mny Jun Jul Aug scp Oct Nov 0H.0 0 0 0 0 0 0 0 0 0 0 0 Jrn rd,Mer Apr Mey Jun Jul Aug sep Oct Nov Itec Yerr Total I.0 0 0 0 0 0 0 0 0 0 0 0 0 Jan Ir€b Mrr Apr Mry Jun Jul Aug $ep Oct Nov Ilec Yerr Total K.0 0 0 0 0 0 0 0 0 0 0 0 0 Jnn Feb Mar Apr May Jun Jul Aug sep Ocl Nov Dec Yenr Totrl 0 0 0 0 0 0 0L.0 0 0 0 0 0 Recertllication Method: ETC I certiff that the compary listed above has procedures in place to rccertiff tho continued eligibility of all of ie Lifeline subscribers, and that, to the best of my knowledgo, the company obtained signed certifications from all subscribers attesting to their continuing oligibility for Lifeline, I am an officer of the company named above. I am authorized to make this certification for the SACG) listed above. Inltlal Recertificatlon Method: Thlrd Party I certi$ that the company listed above has procedures in place tro recortiS consumer eligibility by relying on an administrator, I am an officer of the company named above. I am authorlzed to rnake this ce,rtification for the SAC(s) listed above. InttH MM No Subscrlbers I certifr that ruy company did uot claim federal low income support for any Lifeline subscribers for the ourent Form 555 data year. I am an officsr of the company named above, I am authorized to mako this certification for the SAC listed above. Inltlel SlgnrtureBlock By signing below, I certify that the company listed above is in compliance with all federal Lifeline certification procedurcs. I am an offioer of tho company named above. I am authorized to make this certifioation for the Study Area C,ode (SAC) listed above. Signed, tvla*RMartell Signature of Officer mark@rtci.not Bmail Address of Officer Theresa Wilson Pcrson Complcting This Ccrtillcdion Form Mark R Martell Printed Nrme and Titlc of Officcr Jan 1A,2022 Date 2A83662614 Contrd Phone Number M=(c+K)1r1=1DlI.{)O = f,I/Nrl00 Total number ofrubrcrlbere de-enrolled ar a rcrult o[ rccertlltcrtlon Total number of rubrcrlbers ETC ts rospordblc for reeertt$lng Porcent ofrubscrlberc due for recertlllcatlon ryho werc de-enrolled 0 0 0.0% s Afliliated ETCs SAC Name 6