20220202TracFone Wireless Form 555.pdf

TRACF@NE'
wireless, inc.
VIA OVERNIGHT MAIL
Jean Jewell, Secretary
Idaho Public Utilities Commission
472W. Washington St.
Boise, lD 83720
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January 31,2022
Re: TracFone Wireless, lnc. - FCC Form 555 Report
Dear Ms. Jewell:
ln accordance with the Federal Communication Commission's Lifeline Reform Order
and 47 CFR 54.416(b) please find enclosed a copy of the FCC Form 555 Report of TracFone
Wireless [nc. ("TracFone"). You may reach me at [phone] if you have any questions.
Sincerely,
Stephen Athanson
Regulatory Counsel
www.tracfone.com lwww.netlo.corn I www.straighttalk.corn I www.safelink.com
Annual Lifeline Eligibte 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
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: Jonuary 31* (Annually)
Does the reporting company have affiliated ETCs? Yes f,fl No @
Provide a list of all ETCs that are ffiliated u,ith the reporting ETC. using page J and additional sheets if necessary. Affiliation shall be
determined in accordance with Section 3(2) of the Communiccttions Act. That Section de-fines "affiliate" as "a person that (directllt or indirecllt')
o\yns or controls, is otvned or contt'olled by. or is under common ov,nership or contol w ith. onother person. " 17 U.S.C. S I 5 3 (2). See also 17
c.F.R. $ 76.t200.
Affiliated ETC's SAC Affiliated ETC's Name
479021 143030103
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecontmunications Carrier (ETC) mtrst provide a certification.forntfor each SAC through v,hich it provides Lifeline semice).
2021 ID TracFone Wireless lnc
Recertification Year
SafeLink Wireless
State ETC Name
TracFone Wireless lnc
DBA, Marketing, or Other Branding Name
(lf same as ETC name. list "N'.4" Do not leave blank)
Holding Company Name
(lfsome as ETC nante, list "NiA" Do not leate blank)
1
ETCs Subject to the Non-Usage Requirements
subscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements? Yes @ No @
I,f yes. record the number of subscribers de-enrolled.[or non-usqge by month in Blocli Q belott'.
P 0
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
Mav 164
J une 19
July 14
August 5
September 3
October 1
November 10
December 5
Total Subscribers 221
For purposes of this fi1ing, an officer is an occupant of a position listed in the article of incorporation. articles of fonnation,
or other similar legal document. An officer is a person who occupies a position specified in the corporate by-laws (or
partnership agreement). and would typically be president. vice president for operations, vice president for finance.
cornptroller. treasurer. or a comparable position. If the filer is a sole proprietorslrip. the owner must sign the certification.
Initial Certificatiort All ETCs nnrst conplere this seoiotl
I certify 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 hous{hold
incorne and/or program-based eligibility prior to his or her enrollment in Lifeline; and/or
B) Confinn consumer eligibility by relying upon access to a state database and/or notice of eligibility frorn 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 I
above.
JRInitial
isted
2
Annual Recertification
Do not leave entptv blocks. Ifan ETC futs nothing to report in a block. enter d :ero.
Report the nurnber of Litbline subscribers due tbr recertillcation b) rnonth (Januarl-Decernber)
A. Subscribers eligible tbr recertitlcation by anniversary month
B. Subscribers de-enrolled prior to recertilication attemptsC. Total nunrber ol'subscribers E1-C is responsible tbr reccrtilying (A-B)
Recertifi cation Methods
State of federal databaseD. Subscribers recertifled through E'l'C access to state or lbderal database b1' anniversary month
the number ol subscribers verrtled access to a state or f'ederal database
E. Name ol'the data source(s) used to verifl' consurner eligibiliq:
ETC Direct ContactF. Subscribers contacted by ETC directll'to recertil\'(You ma1'also use this section to report subscriber initiated recertitlcations).
the number ol Littline subscribers the ETC contacted di to obtain recertitlcation of
C. Subscribers rvho l'ailed to recertiti through ETC direct outreach attenlpt
the number of Lit'eline subscribers de-enrolled due to inel or non-to the ETC's outreach
3
.lan Feb l\lar .{pr \lay Jun Jul Aug sep Oct Nov Dec 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 Ma;'Jun .Iul Aug Sep Oct Nov Dec Year
T otal
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Apr Ntay Jun JulFebMar Aug sep Oct Nov Dec l ear
Total
F 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Nlar Ap.Mav Jun Jul Aug Sep Oct Nov Dec \'ear-Ibtal
G.0 0 0 0 0 0 0 0 0 0 0 0 0
H. Subscribers rvho recertitled through ETC direct outreach attempt
the numhc.r ol t-it'eline subscnbers that ETC's outreach attenr
Third Party
I. Subscribers rvhose eligibilitl rvas revieu,ed b) state administrator. third party adnrinistrator. or l.ISAC
the number ol l-it'eline subscribers contacted a state adnrinistrator. third administrator. or [JSAC fbr the
.1. Name olthird paq administrator used to veriti'subscriber eligibilitl
K. Subscribers de-enrolled as a result ofa third party' recertiiication attempt
lhe nurnber ol subscrrbers as a result ol'inel to outreach tiom a state adnrinistrator. third administrator. or USAC
ot'recertillcatron.
or
L. Subscribers uho recertified through a state administrator. third partl adrninistrator. or USAC's recertiflcation ef'lbrt
the number of subscribers that recertifled fiont a state adnr third adrt or USAC
Certification:
Recertification Method: Database
I certifo that the company listed above has procedures in place to recertify 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 NIar .\p.\la1 Jun Jul ,\us Sep Oct Nov Dec Year
T'otal
H 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Nlar Apr NIay'Jun Jul Aug Sep Oct \-ov Dec \ ear
Total
L 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Nlar Ap.\lav Jun .lul Aug Sep Oct )iov Dec Year
I otal
K.0 0 0 0 0 0 0 0 0 0 0 0 0
Apr May Nov Dec I car
Total
Jan Feb Mar .lun Jul Aug Sep Oct
L 0 0 0 0 0 0 0 0 0 0 0 0 0
Recertification Method: ETC
I certify that the company listed above has procedures in place to recertify the continued eligibility of all of its Lifelirre
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 recertify consumer eligibility by relying on an
administrator. I am an officer of the company named above. I am authorized to make this cerlification forthe SAC(s)
listed above.
Initial
No Subscribers
I certify that my company did not claim federal low income slrpport 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 JR
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.
Signed.
Javier Rosado. Sr. Officer Alternative Javier Rosado, Sr. Officer Altern
Signature ol'Ot'ficer
[e-mail]
Enrail Address of Oflicer
Janet lr4orejon
Person Completing This Certification Fornt
Printed Name and Title olOtficer
Jan 29,2022
I)ate
305-715-6522
Contact Phone Number
i\l : (G+K)N = (D+F+I)o: M/N*t00
Total number ofsubscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent ofsubscribers due for
recertilication who were de-enrolled
0 0 0.0%
5
Affiliated ETCs
SAC Name
6