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Home My WebLink About20220131Boomerang Wireless Form 555.pdfiiiicEii/ED :,,;j ifii'i 3l fiH B' 59(.omplianrc Solutionsaaa XN2.2022 crtabt ait'I, 20 \rrn ol5cflE Lr I|d c(IurLa€a rr,cat. :.-r ,r'l Iri;'.ll jtarL., r.'.-, I iJi/L-iV -1 i i-. : i r,: ::. i_:i,:i,iiJ illslsH January 28,2022 Commission Secretary ldaho Public Utilities Commission P.O. Box 83720 Boise,lD 8372O-OO74 RE: Docket ]to. GilR-T-22-{11- FCC Form 55S-,Annual Ufiellne Certlficatlon- Flled on behalf of Boomerang Wrcless, Ll9dlbla enTouch Wreless Dear Secretary, Pursuant to FCC requirements under 47 C.F.R. S 54.416, enclosed please find for filing in the above- referenced docket a copy of Boomerang Wireless, LLC dlbla enTouch Wireless' FCC Form 555 - Annual tifeline Eligible Telecommunications Carrier Certification. lf you have any questions regarding this filing, phase contact me at (407) 2@1011 or regulatory@csllongwood.com. Mark Lammert Attorney-in-Fact Boome ra ng Wireless, ttc d lb I a enTouch Wireless Enclosures Annurl Lifeline Eligible Telecommunicetions Carrier Certificetion Form All carriers must conrplete all or portions of all sections Form must be submitted to USAC and filed with the Fedcral Communications Commission IMPORTANT: PLEASE READ INSTRUCTIONS FIRST Deadline: ,Ianuary ilt (Annuolly) Does the reporting company have aflitieted ETCs? Yes E[ No E[ Provide a list ol'all ETCs that arc ffiliated w'ith the reporling ETC, u.sing pagc 4 and additional sheeu if nccessary. Alfiliation shall he deterntined in acconlance with Section 3(2) of the Communications Act. That Section defu* "ofiliate" as "a person that (directly or lndirectly) ou'ns or conlrols, is ou'ncd or controllcd br,, or is under common ov,ncrship or control l,l.ith, anolher pcrson." 47 U.S.C. .0 153(2). Sce also 47 cF.R. $ 76.t200. Affiliated ETC's SAC Affiliated ETC's Name 479022 143036595 Study Area Code (SAC) Service Provider Identification Number (SPIN) (An Eligible Telecommunicatktns Canier (ETC) must provide a certification.formfor cach SAC through which it provides Lileline senice). 2021 ID Boomerang Wireless LLC Recertification Year enTouch Wireless State ETC Name HH Ventures LLC DBA, Marketing, or Other Branding Name 1lf some as ETC nome, list "N/A" Do 4tt leave hlonk) Holding Company Name (Usane os ETC nane. li.rt "N/1" Do not leave hlan*) 1 ETCs Subject to the Non-Usege Requirements All ETCs must c'omplcte the appropriate check-box. ETCs that do not assess and collect a monthlylcelrom their Ldeline subscribers arc subjcct to the non-usage requiremenls. ETCs subjecl lo the non4,soge requiremenls must indicate the number ofsubscribers de-enrolled by nonth in Scction 4. ETCs that only asscss a lee bul do not collect such fees are subJect to the non-usage reguirements and must also indicote the number a! subscribers de-enrolled bv month. Is the ETC subiect to the non-usrge requirements? Yes E[ No E[ ll .vet, record the nun$er of subscribers de-enrolled for non-usage by month in Block Q below. P o Month Subscribers De-Enrolled for Non-Usaee January 0 February 0 March 0 April 0 May 6 June 4 July 3 August 0 Septenrber 1 October 1 November 3 December 5 Total Subscribers 23 For purposes of this filing, an oflicer is an occupant of a position listed in the article of incorporation, articles of formation, or other similar legal document. An otTicer is a person who occupics a position specified in the corporate by-laws (or partnership agreemcnt), and would typically be president, vice president for operations, vice president for finance, comptroller, treasurer, or a comparablc position. If the filer is a sole proprietorship, the owner must sign the certification. Initial Certificetiott Att ETCs must complete thb se<tion I certi$ that the company listed above has certification procedures in place to: A) Review income and program-based etigibility documentation prior to enrolling a consumcr 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 acccss 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 authorized to make this certification for thc Study Area Code listed above. DHInitia! 2 Annual Recertification Do nol laave empty hhtks. lf an ETC has nolhing to report in a block, enter a zerc. Rcport the number of Lifeline subscribcrs duc for reccrtification by month (January-Dccember) A. Subscribcrs cligible for rcccrtification by anniversary monthB. Subscribcrs de-enrolled prior to rcce(ification attemptsC. Total number of subscribers ETC is rcsponsiblc for recertifying (A-B) Recertlllcatlon Methods Stste of federal drtabeseD. Subscribcn recertified through ETC access to state or fcderal database by anniversary nronth thc numbcr of to E. Name of the data sourc(s) used to veri$ consumer cligibility: ETC Dlrect ContrctF'. Subscritrers contactcd by ETC dircctly to recertify (You may also use this section lo reporl subscribcr initiatcd rcccrtifications) thc numbcr of Lifclinc subscribcrc thc ETC contactcd to obtain rcccrtification of C. Subscribers who failed to rcce(ify through ETC dircct outreach attempt drc of to incl (x lo the ETC'S oulrcrch 3 Jra Fcb Mrr Apr Mry Jun Jul Au8 scp Oct Nov Dcc Yerr Totrl 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 Jro Fch Mr Apr Mey Jun Jul Aug sep Oct Nov Dcc Ycar Totgl D.0 0 0 0 0 0 0 0 0 0 0 0 0 Jrn Feb Mer Apr Mry Jun Jul Au8 sep Oct Nov Dcc Ycrr Totrl F 0 0 0 0 0 0 0 0 0 0 0 0 0 Jrn Fcb Mrr Apr Mry Jun Jul Aug scp Oct Nov Dec Ycer Totrl c.0 0 0 0 0 0 0 0 0 0 0 0 0 H. Subscribers who reccrtified through ETC direct outreach attempt the numbcr of Lifeline Thlrd Partyl. Subscribers whosc eligibility was reviewed by state administrstor, third party adminisrrtor, or USAC the numbcr of Lil'eline subrcribcn coitacted r state adrninistrator third or for the of reccrtificatior. J. Namc of third party rdministrator uscd lo vcrify subscriber cligibility: K. Subscribers de+nrollcd ss a result of a third pany rccc(ification attempt thc numbcr ofsubscribcrs as a rcsult of from a ststc drird 1.. Subscribers who recertificd through a state administrator, third prrty administrator, or USAC's reccrtification efTort the number of thet recc"rtificd &from a strte administntor third adminisuator or USAC Certllicadon: Recertilicetlon Method: Drtabase I certify that the company listed above has procedures in place to recerti$ consumer eligibiliry by relying on a dakbase anr an olTicer of the company named above. I am authorized lo make this certification for the SAC(s) listed above. lnirtal DH 4 Apr Mry JunJrnFebMrr Jul Aug Scp Oct Nov Dcc Yerr Totel H 0 0 0 0 0 0 0 0 0 0 0 0 0 Mrr Apr Mry Jun Jul Aug scp Oct Nov Dec Yeer Totel Jrn Feb t.0 0 0 0 0 0 0 0 0 0 0 0 0 Jen Feb Mrr APr Mey Jun Jul Aug sep Oct Nov Dcc Ycer Totrl K 0 0 0 0 0 0 0 0 0 0 0 0 0 Mry Jun Oct Yerr Totrl Jen Feb Mrr Apr Jul Aug scp Nov Dec L.0 0 0 0 0 0 0 0 0 0 000 Recertiflcatlon 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 from all subscribers attesting to their continuing eligibility for Lifelinc. I am an officer of the company named above. I am authorized to make this ccrtification for the SAC(s) listed above, lnitial DH Recertification Method: Third Party I certify that the company listed above has procedures in place to recertiry 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. lnitial DH No Subscribers I certify that my company did not clairn federal low income support for any Lifelinc subscribers for the current Form 555 data year. I am an officer of thc company named above. I am authorized to make this certification for the SAC listed above. Initial DH Signrture Block By signing below, I certi$ that the company listed abovc is in compliance with all fcdcral Lifcline 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, Dennis Henderson Dennis Henderson Signature ofC)fficer regulatory@entouchwireless.com Email Addrcss of Oflicer Jodie Grimshaw Pcrson Completing This Ccrtification Form Printcd Name rnd Title of Ofliccr Jan28,2022 Date 31 92946080 Contact Phone Number 5 M=(c+K)N - (D+F+t)O-M/Nrtfil Totrl number of rubscrlbcrs de.enrolled rs r rcrult of recertlflcrtion Told aumber of rubrcrlberr ETC ls rerpondblc for rccertlfylng Perccnt of rubrcrlbcrr due for recertlflcrtlon who were de-eorolled 0 0 0.0olo Affiliated ETCs SAC Name 5