20220201Global Connection Form 555.pdf

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
IMPORTAI\T: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 31st (Annually)-T- 27-o t
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. Afiiliation shall be
determined in accordance with Section 3(2) ofthe Communications Act. That Section de/ines "afiiliate" as "a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common ownership or control wilh, another person." 47 U.S.C. S 153(2). See also 47
c..F.R..{ 76.r200.
Affiliated ETC's SAC Affiliated ETC's Name
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Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certiJicationformfor each SAC through which it provides Lifeline service).
2021 lD Global Connection lnc of America
479024 '143034313
State ETC Name
Global Connection Holdings Corporation
Recertification Year
Stand Up Wireless
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do rut leave blank)
Holding Company Name
(lf same 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
to lhe non-usage requirements. ETCs subject to the non-usage requirements must indicate the number ofsubscibers 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 EE t{o EE
If yes, record the number of subscibers de-enrolled for non-usage by month in Block Q below.
P o
Month Subscribers De-Enrolled for Non-Usase
January 0
February 0
March 0
April 0
May 3
June 2
July 0
Auzust 2
September 1
October 3
November 4
December 5
Total Subscribers 20
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 agreernent), and would typically be president, vice president for operations, vice president for finance,
comptroller, treasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sigr the certification.
Initial Certificatiorl All ETCs nust complete this secrion
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 administrator prior to enrolling a consumer in the Lifeline program.
I am an oflicer of the company named above. I am authorized to make this certification for the Study Area Code listed
above.
eisInitial
2
Annual Recertification
Do not leave empty blocks. 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-December)
A. Subscribers eligible for recertification by anniversary monthB. Subscribers de-enrolled prior to recertification atternptsC. Total number of subscribers ETC is responsible for recerti$inS (A-B)
Recertilication Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
database.
E. Name of the data sourc{s) used to veriry consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifr (You may also use this section to report subscriber initiated recertifications).
ETC
G. Subscribers who failed to recertiry through ETC direct ouheach attempt
the de-€nrolled due to or
3
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Totd
A.0 0 0 0 0 0 0 0 0 0 0 0 0
B.0 0 0 0 0 0 0 0 0 0 0 0 0
C.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Totrl
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Jen Feb Mer Apr May Jun JUI Aug sep Oct Nov Dec Yeor
Total
F 0 0 0 0 0 00 0 0 0 0 0 0
Apr MryJanFebMer Jun Jul Aug sep Oct Nov Dec Yor
Total
G.0 0 0 0 0 0 0 0 o 0 0 0 0
H. Subscribers who recertified through ETC direct ouheach attempt
Third PartyI. Subscribe,m whose eligibility was rwiewed by state administrator, third party administrator, or USAC
the number ofLifeline subscribers contacted a state third oTUSAC forthe ofrecertification.
J. Name of third party adminishator used to veri$ subscriber eligibility:
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number ofsubscnibers as a result of or to outr€ach fiom a state lhird orUSAC.
L. Subscribers who recertified through a state administrator, third party adminisfator, or USAC's recertification effort
the number ofsubscribers tha recertified a fi,om a state lhird or USAC
Certification:
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 omcer of the company named above. I am authorized to make this certification for the SAC(s) listed above.
Initiel
4
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Doc Yerr
Totel
H.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
Totrl
I.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Year
Totd
Mar Apr May Jun Jul Aug sep Oct Nov Dec
K.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
Totel
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 sigrred certifications from all subscribers attesting
to their continuing eligibility for Lifeline. I am an officer of the company named above. I arn 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 consurner 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
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,
Eric Schimpf, COO Eric Schimpf, COO
Signature of Offic€r Printod Name and Title of Officer
Jan 31,[e-mail]
Email Address of Officer Date
470-990-2048Ryan Moxom
Person Corpleting This Certification Fonn Contact Phone Number
14 = (c+K)1rg=@+F+I)O = M/l{*llX)
Total number ofcubscribers de-enrolled es
a result of recertificadon
Totel number of subscriben ETC is
rerponsible for necerdfylng
Percent ofsubser{ben due for
recerdfication who were de-enrolled
0 0 0.0o/o
5
Affiliated ETCs
SAC Name
6