20220126Viasat Carrier Services Form 555.pdf

THEcoMMPLIANCE HoME oF THE AccuComplionce Suite or coMpLTANCE soLUTroNS
GROUP Accuticense . AccuReg . AccuTox ' AccuCorp . AccuAgent
January 25,202L
Idaho Public Utilities Commission
11331 W. Chinden Blvd.
BuiHing 8, Suite 201-A
Boise, ID 83714
RE: Viasat Carrier Serwices, Inc. - Case No. GNR-T-21-O1 - 2022
FCC Form 555 - Annual Lifeline Eligible Telecommunications Carrier
Ceftification - Idaho
Dear Staff,
Purcuant to FCC requirements under 47 C.F.R. S 54.416, enclosed please find for a
copy of Viasat Carrier Services, Inc.'s FCC Form 555 - Annual Lifeline Eligible
Telecommunications Carrier Certification. As the filing indicates, the company has not
yet begun providing Lifeline seryice to Idaho subscribers.
If you have any questions regarding this filing, please contact me at (703) 7L#L324 or
ma p@com mpl ia nceq rou p.com.
Respectful ly Submitted,
U)ALilhA-Q-,
Marsha A. Pokorny
Managing Consultant on behalf of Viasat Carrier Services, lnc.
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Annual Lifeline Eligible Telecommunications Carrier Certification X'om All carriers must complete all or portions
of all sections Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTAIIT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 31't (Annually)
Does the reporting company have affiliated ETCs? Yes E[ No E[
Provide a list of all ETCs that are afiliatedwith the reporting ETC, usingpage 4 and additional sheets if necessary. Affliation shall be
determined in acardance with Section 3(2) of the Communications Act. That Section defines "afiiliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is tmder 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
479026 1430517il
Study Area Code (SAC) Service hovider Identification Number (SPh|
(An Eligible Telecommunications Carrier @TC) must provide a certificationfonnfor each SAC throughwhich it provides Lifeline service).
2021 ID ViaSat Carrier Services lnc.
Recertification Year
N/A
State ETC Name
ViaSat, lnc.
DBA, Marketing, or Other BrandingName
(If same as ETC name, list "N/A" Do rut lene bhnk)
Holding Company Name
(If same as ETC name, list "N/A" Do not leove blank)
1
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do nol assess and collect a monthlyfeefrom their Lifeline subscribers are subjecl
to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number of subscribers de-enrolled by month in
Section 4. ETCs that only assess afee but do not collect suchfees are subjecl to the non-usage requiremenls and must also indicate the number of
subscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements? yes EE t{o Ell
Ifyes, record the number ofsubscribers de-enrolledfor non-usage by month in Block Q below.
P 0
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
May 0
June 0
July 0
Ausust 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 Certificatioa, Ail 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 progftrm-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 adminisffator 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.
RBInitial
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 attemptsC. Total number of subscribers ETC is responsible for recertifring (A-B)
Recertifi cation Methods
State of federel databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
subscribers verified access to a state or federal database.
E. Name of the data source(s) used to verifo consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recsrtiry (You may also use this section to report subscriber initiated recertifications).
the number of Lifeline subscribers the ETC contacted to obtain recertification of
G. Subsoibers who failed to recertifi through ETC direct outreach attempt
the number of Lifeline subscribers de-enrolled due to or to the ETC's outreach
the
3
Jgn Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Yeer
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
Apr MayJenFebMar 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 Mav Jun Ju!Aug Sep Oct Nov Dec Year
Totel
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
Totrl
G 0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers who recertified through ETC direct outeach attempt
the Lifeline subscribers that recertified ETC's outreach
Third Party
I. 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 veriry subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number ofsubscribers as a result of or to outreach from a state third
L, Subscribers who recertified through a state adminishator, third party administrator, or USAC's recertification effort
the number ofsubscribers that recertified from a state administrator third or USAC
or USAC.
a
Certification:
Recertification Method: Database
I certi$ that the company listed above has procedures in place to recertiff consumer eligibility by relying on a database. I
am an omcer of the company named above. I am authorized to make this certification for the SAC(s) listed above.
Initial
4
Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Totrl
Jen Feb
0 0 0 0 0 0 0 0 0 0 0H.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
Jen Feb Mer Apr May Jun Jul Aug sep Oct Nov Dec Year
Totel
K.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug sep 0ct Nov Dec Year
Total
L.0 0 0 0 0 0 0 0 0 0 000
Recertification Method: ETC
I certiff that the company listed above has procedures in place to recertiff 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 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 RB
Signature Block
By signing below, I certiff 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,
Robert Blair
Signature of Oflicer
[e-mail]
Email Address of Offrcer
Shelby Striegel
Person Completing This Certification Form
Robert Blair
Printed Name and Tifle of Officer
Jan 14,2022
Date
888-463-9333
Contact Phone Number
M=(G+K)N = (D|F+I)O = M/]\*lfi)
Total number of subscribcrs de-enrolled as
a result of recertification
Total number ofsubscribers ETC is
responsible for recertifying
Percent of subscribens due for
recertilication who were de-enrolled
0 0 0.0o/o
5
Affiliated ETCs
SAC Name
5