20220131Qwest Southern Idaho Form 555.pdf

January 3I,2022
LUMEN'
Yia Email Submission
s e cretary@1t u c. ida h o. go v
Ms. Jan Noriyuki, Secretary
Idaho Public Utilities Commission
I1331 W. Chinden Blvd., Bldg. 8, Ste. 201-A
Boise,ID 83714
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TI
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Re: Docket No. GNR-T-22-01
Qwest Corporation dba CenturyLink QC (Southern ldaho) -
2021 Lifeline Re-Certification Results Reported to the FCC
and USAC
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Dear Ms. Noriyuki:
Pursuant to the Federal Communications Commission's Report and Ordertrequiring
eligible telecommunications carriers to re-certiff the eligibility of their Lifeline subscribers and
to report the results to the Federal communications Commission, Universal Service
Administrative Company and to the state commission and Tribal govemments, CenturyLink QC
(Southern 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 exce,pt 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
thern in with zeros where the National Verifier has taken over.
Please do not hesitate to contact me at [phone] or via email at
[e-mail] should you have any questions regarding this filing.
Sincerely,
lsl Timothy D. Kunkleman
Timothy D. Kunkleman
Director, Government Affairs
TDIVjga
Attachments
ln the Matter of Lifeline and Link Up Reform and Modemization, Lifeline and Link Up, Federal State Joint
Board on Universal Service, Advance Broadband Availability Through Digital Literacy Training, Report and
Order and Further Notice of Rulemaking,2T FCC Rcd 6656,6715-16fi32 (2012);47 C.F.R. $54.416. Also see
Public Notice, 28 FCC Ptcd 12947 (2013).
931 14u'Street
Denver, CO80202
303-992-5810
[e-mail]
Annual Lifeline Etigible Telecommunications Carrier Certification Fonn 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 31't (Annually)
Does the reporting company 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 j(2) ofthe Communications Act. That Section de/ines "afiiliate" as "a person that (directly or indirectly)
oy)ns or controls, is owned or cofirolled by, or is under ammon ownership or control with, another person." 47 U.S.C. S 153(2). See also 47
c.r'.n $ 76.t200.
Affiliated ETC's SAC Affiliated ETC's Name
475103 143005231
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier @TC) must provide a cetificationformfor each SAC through which it provides Lifeline service).
2021 ID CenturyLink Qwest Corporation
Recertification Year
N/A
State ETC Name
Lumen Technologies, lnc.
DBA, Marketing, or Other Branding Name
(lf sane as ETC rame, list "N/A" Do rut lene blank)
Holding CompanyName
(If sane as ETC name, list "N/A" Do not leave blan*)
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 subscibers are subject
to the 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 rubject 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 EE No E[
Ifyes, record the number ofsubscibers 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
Aoril 0
May 0
June 0
July 0
Auzust 0
SeDtember 0
October 0
November 0
December 0
Total Subscribers 0
For purposes of this filing, an officer 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
partrership agreement), and would tlpically be president, vice president for operations, vice president for finance,
compffoller, freasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sign the certification.
Initial Certificatioa Ail ETCs must 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) 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 consruner 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.
AGInitial
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-Decernber)
A. Subscribers eligible for recertification by anniversary monthB. Subscribers de-enrolled prior to recertification attempts
C. Total number of subscribers ETC is responsible for recertiffing (A-B)
Recertifi cation Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of subscribers
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 initiated recertifications).
the number of Lifeline
G. Subscribers who failed to recertiff through ETC direct outeach attempt
the number of Lifeline due to
3
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov I)ec Year
Total
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 Mey Jun Jul Aug sep Oct Nov Dec Year
Total
D.0 0 0 0 0 0 0 0 0 0 000
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
F 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
0 0 0G.0 0 0 0 0 0 o 0 0 0
H. Subscribers who recertified through ETC direct ouheach attonpt
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number of Lifeline subccribers conbcted a state third or USAC forthe 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 ofsubscnlbers as a result of or to out€ach from a state lhtud afuinistrator or USAC.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertificaion effort
the number ofsubscribers rhat recertified a from a state lhtud oTUSAC
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 offlcer of the company named above. I am authorized to make this certification for the SAC(s) listed above.
Initial
Jen 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 Mer Apr Mey Jun Jul Aug Sep Oct Nov Dec Yeer
Totel
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 May Jun JUI Aug sep Oct Nov Dec Year
Total
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 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 certify that the company listed above has procedures in place to recerti$ 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.
Initial AG
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.
Sigrred,
Andrea SVP Controller
Signature of Officer
ANDREA.GENSCHAW@LU MEN
Email Address of Officer
Heather Malone
Person Conpleting This Certification Form
Andrea Genschaw, SVP Controll
Printed Name and Title of Offioer
Jan 31 ,2022
Date
3183306442
Contact Phone Number
M=(G+K)11 = @+F+I)O = M/.I\l*Ifi)
Total number of subscribers de-enrolled as
a result of recerfification
Totel number of subscrlbers ETC ls
responsible for recertifylng
Percont of subscribers due for
recertilicadon who were de-enrolled
0 0 0.0%
5
Affiliated ETCs
SAC Name
472225 Centurvlink CenturvTel of ldaho lnc.
472223 CenturvLink CenturyTel of the Gem State (Nevada)
475162 CenturvLink Qwest Corooration
5