20220131Cingular Wireless Form 555.pdf

9Ar&r
Janice Ono
Area Manager - Regulatory
AT&T Services, Inc.
5250 S. Virginia Street
Room 202
Reno, NV 89502
T:775.333.399t
Mi 775.527.3365 :.--i -i J:[e-mail]
. , t.i r. l nrl . - t f I. .l u i, v r I i, 'r,'r:J
Via Email
January 31,2022
Ms. Jan Noriyuki
Commission Secretary
Idaho Public Utilities Commission
11331 W. Chinden Blvd.
Building 8, Suite 201-A
Boise,ID 83714
secretary(@Fuc.idaho. gov
Re: FCC Form 555. Annual Lifeline Eligible Telecommunications Carrier Certilication
Form for New Cineular Wireless PCS. LLC ("AT&T Mobilitv')
(Docket GNR-T-22-01)
Dear Ms. Noriyuki:
On behalf ofNew Cingulm Wireless PCS, LLC (dba "AT&T Mobility"), attached please find a
copy of FCC Form 555. t AT&T Mobility is providing you with a copy of this FCC filing in
accordance with47 C.F.R. |.5a.a22@\ Receipt of this information requires NO action on your
part. It is strictly informational.
If you have any questions concerning this matter, please do not hesitate to call me to discuss. I
can be reached at 77 5.333.3991.
Sincerely,
Janice Ono
Daniel Klein, ID PUC Daniel. Klein(rDnuc.idaho. eov
Isabelle Salgado, Esq. (is-!-6 I [e-mail])
Attachment
I AT&T Mobility filed its FCC Form 555 online with the Universal Service Adminishative Company (USAC).
Once a carrier enters its six-digit study area code (SAC) into USAC's online FCC Form 555, the online tool
automatically populates a name associated with that SAC. In some cases, this automatically-generated name differs
from (e.g., is an abbreviated version of) the legal entity name for AT&T Mobility's eligible telecommunications
carrier affiliate.)
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Annual Lifeline Eligible Telecommunications Carrier Certilication 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 3k (Annually)
Does the reporting company have affiIiated ETCs? Yes Eil No E[
Provide a list of all ETCs that are afiiliated with the reporting ETC, using page 4 and additional sheets if necessary. Afiliation shall be
determined in accordance with Section 3(2) of the Communicalions Act. That Section de/ines "affliate" as "a person that (directly or indirectly)
oww 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
479006 143029765
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecomrnunications Carrier @TC) must provide a certificationformfor each SAC through which it proides Lifeline senice\.
2021 lD Cingular Wireless
Recertification Year
N/A
State ETC Name
AT&T lnc.
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do twt leave blank)
Holding Company Name
(lf same as ETC name, list "N/A" Do not leave blank)
L
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthlyfeefrorn their Lifeline subscibers are subject
b rte non-usage requirements. ETCs subject to rte non-usage requirements must indicate the nutnber of subscibers de-enrolled by month in
Section 4. ETCs that only assess afee but do not collect wch fees are subject to the non-usage requirements and must also indicate the number of
subscibers de-enrolled by month.
Is the ETC subject to the non-usage requirements? yes EE No E[
If yes, record the number of subscrtbers 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
May 0
June 0
July 0
August 0
Seotember 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 officer is a person who occupies a position specified in the corporate byJaws (or
partrrership agreement), and would tlryically be president, vice president for operations, vice president for finance,
compholler, teasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sign the certification.
Initial Certifrcatiott All ETCs nust complez this section
I certifr 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 enrolLnent 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 administrator prior to emolling a consumer in the Lifeline program.
I am an offrcer of the company named above. I am authorized to make this certification for the Study Area Code listed
above.
ALGInitial
2
Annual Recertilication
Do not leave empty bloclcs. If an ETC has nothing to report in a block, enter a zero.
Report the number of Lifeline subscribers due for recertification by month (January-Decernber)
A. Subscribsrs eligible for recertification by anniversary month
B. Subscribers de-enrolled prior to recertification attempts
C. Total number of subscribers ETC is responsible for recertifring (A-B)
Recertilication Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of subscnlbers verified access to a state or fed€ral dstabas€.
E. Name of the data sourc{s) used to veriry consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifu (You may also use this section to report subscriber initiated recertifications).
G. Subscribers who failed to recedif through ETC direct outreach attempt
the number of Lifeline subscribers de-enrolled due to or to the ETC's oufeach
3
Jan Feb Mar Apr May Jun JUI Aug Sep Oct Nov Dec Yerr
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 JUI Aug sep Oct Nov Dec Year
Total
0 0 0 0 0D.0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jut Aug sep Oct Nov Dec Yeor
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
G 0 0 0 0 o 0 0 0 0 0 0 0 0
H. Subscribers who recertified through ETC direct outreach attempt
the number ofLifeline subscribcrs that recertified ETC's outreach
Third PartyI. Subscribem whose eligibility was rwiewed by state administrator, third party adminisbator, or USAC
the number ofLifeline subscribers contacted a state third oTUSAC forthe of recertificatio.
J. Name of third party adminisfrator used to verifr subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertification attempt
tte number ofsubscribers as a result or to outreach from a state lhid orUSAC.
L. Subscribers who recertified through a state adminishator, third party administrator, or USAC's recertification effort
the number ofsubecribers that reccrtified from a state lhid or USAC
Certification:
Recertilication 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 offlcer of the company named above. I am authorized to make this certification for the SAC(s) listed above.
Initiel
Jan Mer Apr May Jun JUIFeb Aug sep Oct Nov Dec Year
Tohl
H.0 0 0000 0 0 0 0 0 0 0
Jan Feb Mer Apr Mry Jun Jut Aug sep Oct Nov Dec Year
Totel
I.0 0 0 0 0 0 0 0 0 0 0 0 0
Jen Feb Mar Apr Mey Jun JUI Aug sep Oct Nov Dec Yerr
Totel
K.0 0 0 0 0 0 0 0 0 0 0 0 0
Jen Feb Mrr Apr May Jun JUI Aug seP tu Nov Dec Yer
Totol
L.0 0 0 0 0 0 0 0 0 0 0 0 0
4
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 oflicer of the company named above. I am authorized 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 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 certiff 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.
166a1 ALG
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.
Sigrred,
Anisa L. Green, Director - Federal Rel Anisa L. Green, Director - Federi
Signature of Officer
[e-mail]
Email Address of Officer
Anisa Green
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 31 ,2022
Date
202425-2417
Contact Phone Number
14 = (c+K)N = (D+F+I)O = M/I\rlfil
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertlfying
Percent of subscrlbers due for
recertificetion who were de-enrolled
0 0 0.0%
5
Affiliated ETCs
SAC Name
209012 Cinqular Wireless
259908 Cinoular Wireless
269905 Cingular Wireless
27SO',t0 Cinoular Wireless
289912 Cinoular Wireless
319026 Cinoular Wireless
389015 ATandT Mobilitv LLC
399015 Cinqular Wireless
409004 ATandT Mobilitv LLC
529910 Cinoular Wireless
2'.t5191 BellSouth Telecommunications LLC
225192 BellSouth Telecommunications LLC
235193 BellSouth Telecommunications LLC
245194 BellSouth Telecommunications LLC
255181 BellSouth Telecommunications LLC
26s182 BellSouth Telecommunications LLC
275183 BellSouth Telecommunications LLC
28518/.BellSouth Telecommunications LLC
295185 BellSouth Telecommunications LLC
3051 50 The Ohio BellTelephone Companv
315090 Michiqan Bell Teleohone Comoanv
325080 lndiana Bell Teleohone Comoanv lncomorated
335220 Wisconsin Bell lnc.
345070 lllinois Bell Telephone Company LLG
405211 Southwestern Bell Telephone Companv
415214 Southwestem Bell Telephone ComDany
555173 Nevada Bell Telephone Company
445216 Southwestem Bell Telephone Company
449022 Cinqular Wireless
53901 0 ATandT Mobilitv LLC
il5'.170 Pacific Bell Teleohone Comoanv
549004 ATandT Corp.
6