20220127Fremont Telcom Form 555.pdf

Blackfoot
Communications
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Lifeline Re-Certification - FCC Form 555
January 27,2022
ldaho Public Utilities Commission
472W. Washington
Boise, !D 83720
Re: WC Docket No. 14-171 and IPUC Case Number GNR-T-22-01
Fremont Telcom Co. ("Fremont') respectfully submits the attached certifications pursuant to 47 CFR
S54.416 (b) and 54.410 (d)as required by the FederalCommunication Commission's Lifeline Reform
Order. The liling has been electronically filed in accordance ldaho Public Utilities Commission staff
guidance.
Please note that Blackfoot is not responsible for recertications of Lifeline consumers in Montana or ldaho,
The directions for form 555 specifically direct filers to include data for those subscribers they were
responsible for certifying. As National Verifier states, Montana and ldaho, recertifications are administered
by USAC.
lf you have questions regarding this filing, please contact me by e-mail at [e-mail] or by
phone at406-541-5131,
Sincerely,
/s/ MLcheLLe owews
Michelle Owens
Reg ulatory SpecialisUParalegal
Fremont Telcom Co.
1221 N, RussellSt.
Missoula, MT 59808
cc: USAC High Cost Low lncome Division
FCC Secretary
1221 N Russell St . Missoula, MT 59808 . 866-541-5000 . blackfootcommunications.com
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
IMPORTAIIT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 3I't (Annually)
Does the reporting company have afliliated ETCs? Yes E No E[
Provide a list of all ETCs that are ffiliated with the reporting ETC, using page 4 and additional sheets if necessary. Afiliation shall be
determined in accordance with Section 3(2) of the Communications Act. That Section deJines "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. S 153(2). See also 47
c.r.R. $ 76.t200.
Affiliated ETC's SAC Affiliated ETC's Name
472222 143002515
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certi/icationformfor each SAC through which it provides Lifeline senice).
2021 ID Fremont Telcom Co.
Recertification Year
N/A
State ETC Name
BTC HOLDINGS INC
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do rct leave blank)
Holding CompanyName
(lf 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 assess and collect a monthlyfeefrom their Ldeline subscribers are sabject
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 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 E[
Ifyes, record the number of subscribers de-enrolledfor non-usage by month in Block Q below.
P o
Month Subscribers De-Enrolled for Non-Usaee
January 0
February 0
March 0
April 0
Mav 0
June 0
July 0
Auzust 0
Septernber 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 ofiicer is a person who occupies a position specified in the corporate byJaws (or
parErership agreanent), and would tlpically be president, vice president for operations, vice president for finance,
comptroller, feasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sign the certification.
Initial Certificatioll Alt ETCs must complete this section
I certi$ 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 consuner 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.
SMInitial
2
Annual Recertilication
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 affemptsC. 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 access to a state or fed€ral
E. Name of the data sourc{s) used to verifr consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertiff (You may also use this sectioo to report subscriber initiated recertifications).
the ETC contacted to obtain recertification of
G. Subscribers who failed to recerti$ through ETC direct outreach attempt
de-enrolled due to or to the ETC's outreach
3
Jan Feb Mer Apr May Jun Jul Aug Sep Oct Nov Dec Year
Totel
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 Jut Aug sep Oct Nov Dec Year
Total
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
Jan Feb Mrr
F 0 0 0 0 o 0 0 0 0 0 0 0 0
Apr May Jun Jul Aug sep Oct Nov Dec Year
Totel
Jan Feb Mrr
G.0 0 0 0 0 0 0 0 0 0000
H. Subscribers who recertified through ETC direct outreach attempt
the number of 's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number of Lifeline subscribers con8cted a sEte trird or USAC for the of recertificatim.
J. Name of third party administrator used to verifr subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number ofsubscn-bers as a result or to outreach from a state adminisrator lhird or USAC.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number ofsubscriben that r€c€rtifi€d a from a state lhid or USAC
Certilication:
Recertifi cation 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 officer of the company named above. I am 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
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 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 Mer Apr Mey Jun Jul Aug sep Oct Nov Dec Year
Total
L.0 0 0 0 0 0 0 0 0 0 0 0 0
Recertification Method: ETC
I certiS 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 sigred certifications from all subscribers attesting
to their continuing eligibility for Lifeline. I am an ofticer of the company named above. I am authoriznd to make this
certification for the SAC(s) listed above.
Initial
Recertification Method: Third Party
I certi$ that the company listed above has procedures in place to recertiS consumer eligibility by relying on an
administrator. I am an offrcer 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
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.
Sigred,
Stacey Mueller CFO Stacey Mueller CFO
Sigrature of Officer
sm [e-mail]
Email Address of Officer
Michelle Owens
Person Completing This Certification Form
Printed Name and Title of Officer
Jan26,2022
Date
406-541-5131
Contact Phone Number
5
y=14+K)N = (D+F+I)O = M/NillX)
Totd number of subscribers de-enrolled as
o result of recertificetlon
Total number ofsubscribers ETC ts
responsible for recertifylng
Percent ofsubscrlbers due for
recertificction who were de-enrolled
0 0 0.0o/o
Affiliated ETCs
SAC Name
5