20220128QLink Wireless Form 555.pdf

Annual Lifeline Eligible Telecommunications Carrier Certilication f,'om All carriers must complete all or portions
of all sections Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTAI\T: PLEASE READ INSTRUCTIONS FIRST
Deadline: fanuary 31't (Annually)
- t-I
Does the reporting comprny have alfiliated ETCs? Yes E[ No E[
Provide a list of all ETCs that are afiliated 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 defines "afiliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common owturship or control with, another person." 47 U.S.C. I 153(2). See also 47
c.r.R. $ 76.t200.
Affiliated ETC's SAC Affrliated ETC's Name
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Study Area Code (SAC) Service Provider ldentification Number (SPE[)
(An Eligible Telecommunications Carrier (ETC) must provide a certificationformfor each SAC through which it proides Lifeline service).
479018 143036il4
ID
State
2021 Q Link Wireless LLC
Recertification Year
N/A
ETCName
Quadrant Holdings Group LLC
Holding CompanyName
(If same as ETC tume, list "N/A" Do rct leave blank)
DBA, Marketing, or Other Branding Name
(If sane as ETC name, list "N/A" Do ttot leave blank)
1
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropiate check-box. ETCs that do not assess and collect a monthlyfeefrom their Lifeline subscribers are subj*t
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-Usage
January 0
February 0
March 0
April 0
Mav 636
June 827
July 2831
Auzust 227
September 392
October 615
November 330
December 319
Total Subscribers 6177
For purposes of this filing, an officer is an occupant of a position listed in the article of incorporation, articles of fonnation,
or other similar legal document. An oflicer 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, Eeasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sign the certification.
Initial Certilicatiort Alt ETCs musr comptete 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 program-based eligibility prior to his or her enrollment in Lifeline; and/or
B) Confrm consumer eligibility by relying upon access to a state database and/or notice of eligibility from the state
Lifeline adminishator prior to enrolling a consumer in the Lifeline program.
I am an offtcer of the company named above. I am authorized to make this certification for the Study Area Code listed
above.
IAInitial
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)
Recertilication Methods
State of federal databaseD. Subscribers recefiified through ETC access to state or federal database by anniversary month
verified access to a state or federal database.
E. Name of the data sourc{s) used to veriry consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifr (You may also use this section to report subscriber initiatod recertifications).
the number subscribers the ETC contacted to obtain recertification of
G. Subscribers who failed to recertiS through ETC direct outreach attempt
thc number ofLifeline subscribers de-enrolled due to ot to the ETC's oufeach
6e
3
Jan Feb Mar 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
Apr May JunJanFebMar Jul 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 AugJanFebMar sep Oct Nov Dec Year
Totel
F.0 0 0 0 0 0 0 0 0 0 0 0 0
Jen Mar Apr May Jun JUI Aug sep Oct Nov Dec Year
Totd
Feb
G.0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers who recertifiod through ETC direct outreach attempt
the number ofLifeline subscriben that reccrtified ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party adminishator, or USAC
the number of Lifeline subscribem contacted a stat€lhird or USAC forthe ofrecertification.
J. Name of third party adminishator used to veriff subscriber eligibility:
K, Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of tr to outr€ach from a stat€third or USAC.
L. Subscribers who recertified through a state administrator, third party adminishator, or USAC's recertification effort
the number ofsubscribers that recertified a from a state lhftd or USAC
Certilication:
Recertification Method: Database
I certiff that the company listed above has procedures in place to recertiff consumer eligibility by relylng 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 Mey Jun Jul Aug sep Oct Nov Dec Yeer
Totel
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 Yeor
Totd
I 0 0 0 0 0 0 0 0 0 0 0 0 0
Jen Feb Mar 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 Oct Nov Dec Ycar
Totd
L.0 0 0 0 0 0 0 0 0 0 0 0 0
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 certiS that the company listed above has procedures in place to recertiff 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 certift 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 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.
Sigred,
Issa Asad-CEO lssa Asad-CEO
Signature of Officer
lssa@quad rantholdings.com
Email Address of Officer
Maybell Kelly
Person Conrpleting This Certification Form
Printed Name and Title of Officer
Jan27,2022
Date
8006101540
Contact Phone Number
5
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Total number ofsubscribers de-enrolled as
a result of reccrdfication
Total number of subscriberr ETC ls
responsible for recertifying
Percent of gubscribers due for
recertification who were deenrolled
0 0 0.0o/o
Affiliated ETCs
SAC Name
6