20220131Qwest Northern Idaho Form 555.pdf

LUMEN"
January 3I,2022
Via Email Submission
s e c r e ta 4@7t u c. i d a h o. go v
Ms. Jan Noriyuki, Secretary
Idaho Public Utilities Commission
11331 W. Chinden Blvd., Bldg. 8, Ste. 201-A
Boise, D 83714
Re:Docket No. GNR-T-22-01
Qwest Corporation dba CenturyLink QC (Northern ldaho) -202lLifeline Re-Certification Results Reported to the FCC
and USAC
Dear Ms. Noriyuki
Pursuant to the Federal Communications Commission's Report and Ordertrequiring
eligible telecommunications carriers to re-certifu the eligibility of their Lifeline subscribers and
to report the results to the Federal Communications Commission, Universal Service
Administrative Company and to state commission and Tribal governments, CenturyLink QC
(Northern Idaho) hereby submits its202l Lifeline re-certification results for the state of Idaho.
Please note that the results are provided separately for each FCC study area. In addition,
the numbers being reported this year are mostly zero as we are no longer handling the
verifications and recertifications. The Lifeline National Eligibility Verifier (National Verifier)
has taken over these functions for all states except the Opt-out-states of Oregon and Texas. Per
USAC's instructions, we are still completing and filing the Form 555 reports; only we are filling
them in with zeros where the National Verifier has taken over.
Please do not hesitate to contact me at [phone] or via e-mail at
[e-mail] should you have any questions regarding this filing.
Sincerely,
/s/ Timothy D. Kunkleman
Timothy D. Kunkleman
Director, Government Affairs
TDK/jga
Attachments
In the Matter of Lifeline and Link Up Reform and Modemization, Lifeline and Link Up, Federal-State Joint
Board on Universal Service, Advancing Broadband Availability Through Digital Literacy Training, Report and
Order and Further Notice of Rulemaking,2T FCC Rcd 6656, 6715-16 nl32 Q0l2);47 C.F.R. $ 54.416. Also
see Public Notice, 28 FCC Plcd 12947 (2013).
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303-992-5810
[e-mail]
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
IMPORTAI\T: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 3k (Annually)
Does the reporting company have afliliated 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 j(2) of the Communications Act. That Section detines "afiliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common ownership or contol vith, 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
475162 143005231
Study Area Code (SAC) Service Provider ldentification Number (SPIN)
(An Eligible Telecommunicattons Carrier (ETC) must provide a certificationformfor each SAC through which it proides Lifeline sentice).
2021 ID CenturyLink Qwest Corporation
Recertification Year
N/A
State ETC Name
Lumen Technologies, lnc.
DBA, Marketing, or Other Branding Name
(If same as ETC name, list'N/A" Do rot leave blank)
Holding CompanyName
(If sane 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 Lifeline subscribers are subject
b rte non-usage requirements. ETCs subject to the non-usage requirements must indicate the number of subscibers de-enrolled by month in
Section 4. ETCs that only assess a fee but do not collect such fees are subjut to the non-usage requiremofis 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 subscibers 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
May 0
June 0
Julv 0
August 0
SeDternber 0
October 0
November 0
December 0
Total Subscribers 0
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 officer is a person who occupies a position specified in the corporate byJaws (or
partnership agreernent), and would tlpically be president, vice president for operations, vice president for finance,
comptroller, treasurer, or a comparable position. If the frler is a sole proprietorship, the owner must sigrr the certification.
Initial Certificatio\ Att ETCs nust comptetc 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 emolling 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 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.
AGInitial
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 recedification by anniversary month
B. Subscribers de-enrolledpriorto recertification atternpts
C. Total number of subscribers ETC is responsible for recerti$ing (A-B)
Recertifi cation Methods
State of federel databaseD. Subscribers recertified 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 veri! consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifr (You may also use this section to report subscnber initiated recertifications).
of the ETC contacted to obtain recertification of
G. Subscribers who failed to recertifu through ETC direct outreach attempt
de-enrollcd due to to the ETC's outreach
of
orof
3
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Yeor
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
May Jun Jul Aug sep Oct Nov Dec Year
Total
Jan Feb Mar Apr
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Mey Jun JUI Aug sep Oct Nov Dec Yeor
Totd
Jan Feb Mar Apr
0 0 0 0 0 0 0 0 0 0F000
Apr May Jun JUI Aug sep 0ct Nov Dec Year
Total
Jen Feb Mar
0 0 0 0 0 0 0 0 0 0G.0 0 0
H. Subscribers who recertified through ETC direct outreach atte,mpt
the number ofLifeline subscribers that recertified ETC's outreach
Third PartyI. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number ofLifeline subscribers contact€d a state lhtud
J. Name of third party administrator used to verify subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number ofsubscribers as a result of
or USAC forthe of rccertificatim.
lhird or USAC.or to outseach from a statc
L. Subscribers who recertified through a state adminishator, third party administrator, or USAC's recertification effort
the number of subscribers that rccertified from a state administrator lhind or USACa
Certilication:
Recertifi cation Method : Database
I certiff that the company listed above has procedures in place to recertiff 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 Mer Apr May Jun Jut Aug sep Oct Nov Dec Year
TotaI
H.0 0 0 0 0 0 0 0 0 0 0 0 0
Dec Year
Tofrl
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov
I.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mer Apr May Jun JUI Aug sep Oct Nov Dec Year
Total
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 Year
Totd
L,0 0 0 0 0 0 0 0 0 0 0 0 0
Recertification Method: ETC
I certifu that the company listed above has procedures in place to recerti$ 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 affesting
to their continuing eligibility for Lifeline. I am an ofiicer 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 recertifu 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 curent Form 555
data year. I am an offrcer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial AG
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,
Andrea Genschaw SVP Controller Andrea Genschaw SVP Controll
Sigrature of Officer
AN DREA.GENSCHAW@LU MEN
Email Address of Officer
Heather Malone
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 31 2022
Date
3183306442
Contact Phone Number
y=14+K)N = 0D+F+r)O = M/N*llX)
Total number of subscribers de-enrolled as
a result of recertificrtion
Total number of subscribers ETC is
responsible for recertifylng
Percent of subscribers due for
recertificetion who were deenrolled
0 0 0.0o/o
5
Affiliated ETCs
SAC Name
472225 Centurvlink CenturvTel of ldaho lnc.
472223 CenturyLink CenturyTel of the Gem State (Nevada)
47s',to3 CenturyLink Qwest Corporation
6