20220114Albion Telephone Company Form 555.pdf

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p 208-673-5335 t t 208-673-6200 I e [e-mail] t a 225 W. North Si;:AbbruP q$11
January L2,2022
ldaho Public Utilities Commission
PO Box 83720
Boise, lD 83720-0074
To Whom lt May Concern:
I am filing a copy of my FCC Form 555 which I have also filed with the FCC and USAC. lf you have any
questions or need additional information, please let me know.
Sincerely,
Kyle Bradshaw
Assistant General Manager
Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers must complete all or poftions
of all sections Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 31't (Annually)
Does the reporting company have affiliated ETCs? Yes @ No @
Provide a list of all ETCr that are ffiliated with the reporting ETC, using page 4 and additional sheets if necessary. AlJiliation shall be
determined in accordance with Section 3(2) of the Commmications Act. That Section defines "ffiliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common ownership or control with, another person. " 47 U.S.C. { I 53 (2). See also 47
c.F.R. .$ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
472213 143002510
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 serttice).
2021 lD Albion Telephone Company lnc.
Recertification Year
N/A
State ETC Name
DBA, Marketing, or Other Branding Name
(If 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)
1
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do not dssess and collect a monthly.feefrom their Lifeline subscribers 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. ETCs that only assess afee but do not collecl suchfees are subject to the non-usage requtrements and must also indicate the nuntber o.f'
subscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements? Yes @ No @
If yes, record the number of subscribers de-enrolled.for 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
Mav 0
June 0
July 0
August 0
September 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 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 Certificati ort Att ETCs must complete this section
I certify 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 authorizedto make this certification for the Study Area Code listed
above.
RRInitial
2
Annual Recertification
Do not leave empt.v blocl<s. If an ETC has nothing to report in a block, enter a zero.
Report the number of Lit'eline subscribers due tbr recertification by month (January-December')
A. Subscribers eligible for recertifrcation by anniversary monthB. Subscribers de-enrolled prior to recertification attemptsC. Total number of subscribers ETC is responsible for recertifying (A-B)
Recertifi cation Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of subscribers vetified access to a state or federal database.
E. Name of the data source(s) used to veri$ consumer eligibility:
ETC Direct ContactF. Subsclibers contacted by ETC directly to recertiff (You may also use this section to repoft subscriber initiated recertifications)
the number of Lifeline subscribers the ETC contacted to obtain recertification of
G. Subscribers who failed to recerti! through ETC direct outreach attempt
the number ofLifeline 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.0 0 0 0 0 0 0 0 0 b 0 I 7
B 0 0 0 0 0 0 0 0 0 0 0 0 0
C 0 0 0 0 0 0 0 0 0 6 0 1 7
Dec Year
Total
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov
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
c 0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers who recertified through ETC direct outreach attempt
tlre number of Lifeline subscribers that successful recertified tlr ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state adminishator, third party administrator, or USAC
the number of Lifeline subscribers contacted a state third
J. Name of third party administrator used to veriff subscriber eligibility:
USAC
K. Subscribers de-enrolled as a result of a third party recertification attempt
or USAC for the of recertification.
Nov Dec Year
Total
Jan Feb Mar Apr May Jun Jul Aug sep Oct
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 0 0 0 0 0 0 0 0 0 6 0 1 7
the number of subscribers as a result of or to outreach from a state administrator, third
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's lecerlification effoft
or USAC.
Jan Feb Mar Apr May Jun Jul Aug sep 0ct Nov Dec Year
Total
0 0 0K.0 0 0 0 0 0 0 0 0 0
the number of subscribers that recertified from a state adm thid oTUSAC
Certification:
Recertification Method: Database
I certify that the company listed above has procedures in place to recerlify 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
May Oct Nov Dec Year
Total
Jan Feb Mar Apr Jun Jul Aug sep
L.0 0 0 0 0 0 0 0 0 6 0 1 7
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 fi'om 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
Recertilication Method : Third Party
I certify that the company listed above has procedules in place to recertify consumer eligibility by relying on an
administrator. I am an officer of the cornpany named above. I am authorizedto make this cerlification for the SAC(s)
listed above.
Initial RR
No Subscribers
I certify that my company did not clairn federal low income support for any Lifeline subscribers for the cun'ent Form 555
data year. I am an officer of the company named above. I am authorizedto make this certification for the SAC listed
above.
Initial
Signature Block
By signing below, I certifu 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,
RICH REDMAN PRESIDENT
Signature of Officer
[e-mail]
Ernail Address of Offrcer
Julie Laumb
Person Completing This Certification Fom
RICH REDTVAN PRESIDENT
Printed Name and Title of Officer
Jan 12,2022
Date
208-673-2208
Contact Phone Number
M = (G+K)p = @+F+I)O = M/N*I00
Total number ofsubscribers 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 7 0.0%
5
Affiliated ETCs
SAC Name
6