20220309Filer Mutual Telephone Form 555.pdf

f*iix FllLENMUTUAL
Tclephone Gompany
March 8,2022
Ms. Jan Noriyuki
Commission Secretary
Public Utilities Commission of ldaho
11331 W. Chinden Blvd. Building 8, Suite 201-A
Boise, lD 83714
RE: IPUC Docket GNR-T-22-01: Annual Lifeline Certification for Filer Mutual
Telephone Gompany, lnc. in ldaho
Dear Ms. Noriyuki,
Filer Mutual Telephone Company, Inc. ("the Company" or "File/') is submitting the
attached informationalfiling to the Public Utilities Commission of ldaho ("Commission")
pursuant to pursuant to 47 CFR 54.416 as adopted by the Federal Communication
Commission (FCC) in its Lifeline Reform Order, FCC 12-11, released February 6,2012.
Section 54.4 16(b) requires eligible telecommunication carriers (ETCs) to annually
provide the results of their re-certification efforts performed pursuant to Section 54.4 10
(f) to the FCC and the Universa! Seruice Administrative Company (USAC). ETCs are also
required to provide the results of their recertification efforts to state commissions and
relevant tribal governments.
Please do not hesitate to call me at [phone] if you have any questions.
Sincerely,
ZUfu
Robert Kraut
General Manager
Enclosures
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
IMPORTAT[T: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 3k (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 3(2) of the Communications Act. That Section deJines "afiltate" as "a person that (directly or indirectly)
owns 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. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
472220 143002513
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Canier @TC) must provide a certificationformfor each SAC through which it provides Lifeline semice).
2021 ID Filer Mutual Telephone Company
Recertification Year
N/A
State ETCName
DBA, Marketing, or Other Branding Name
(If same as ETC name, list "N/A" Do not leave blank)
Holding CompanyName
(lf sane as ETC name, list "N/A" Do not learc blonk)
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 subscriberc 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 E[ No E[
Ifyes, record the number of subscribers 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
Auzust 0
September 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 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 sip the certification.
Initial Certificatioa, Ail ETCs must complete this seaion
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 adminisfiator 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.
RSKInitial
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 recertification by anniversary monthB. Subscribers de-enrolled prior to recertification attemptsC. Total number of subscribers ETC is responsible for recertifing (A-B)
Recertifi cation Methods
State of federal databaseD. Subscribers recertified through ETC access to state or fbderal database by anniversary month
the number of
E. Name of the data source(s) used to verifr consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifr (You may also use this section to report subscriber initiated recertifications).
the ETC contacted to obain recertification of
G. Subscribers who failed O recertifr through ETC direct outreach attempt
the number ofLifeline subscribers de-enrolled due to or to the ETC's outreach
3
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
A.2 0 0 0 0 0 3 0 2 1 2 0 10
B.1 0 0 0 0 0 0 0 0 0 0 0 1
C.1 0 0 0 0 0 3 0 2 1 2 0 I
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
D.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
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 0 0 0 0 0 0 0 0 0
H. Subscribers who recertified through ETC direct outreach attempt
that recertified ETC's outreach
Third Party
L Subscribers whose eligibility was reviewed by state administrator, third party adminishator, or USAC
the number ofLifeline subscribers contacted a starc administrator, third administrator or USAC for the ofrecertification.
Name of third party administator used to veri$ subscribo eligibility:
USAC
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of or to outseach from a state ttird or USAC.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number of subscribers tha recertified a from a state administrator thid oTUSAC
Certification:
Recertifi cation Method: Database
I certiff that the company listed above has procedures in place to recerti$ consumer eligibility by relying on a database. I
am an offrcer of the company named above. I am authorized to make this certification for the SAC(s) listed above.
loiu"t RSK
4
Apr Mey Jun Jul Aug sep Oct Nov Dec Year
Totel
Jen Feb Mer
0 0 0 0 0 0 0 0 0 0H.0 0 0
Jan Feb Mar Apr May Jun JUI Aug sep Oct Nov Dec Year
Total
I.
1 0 0 0 0 0 3 0 2 1 2 0 9
May sep Oct Nov Dec Year
Totel
Jen Feb Mer Apr Jun Jul Aug
0 0 0 0 0 0 0 0 0 0 0K.0 0
Apr May Jun Jut Aug sep Oct Nov Dec Year
Total
Jan Feb Mar
L.
1 0 0 0 0 0 3 0 2 1 2 0 I
Recertification Method: ETC
I certiff that the company listed above has procedures in place to recertify 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.
1ni1id RSK
Recertification Method: Third ParW
I certifu that the company listed above has procedures in place to recertify consumer eligibility by relying on an
administrator. I am an offrcer of the company named above. I am authorized to make this certification for the SAC(s)
listed above.
166a1 RSK
No Subscribers
I certifu 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.
1ai6g1 RSK
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.
Siped,
Robert Kraut COO
Signature of Officer
[e-mail]
Email Address of Officer
Robert Kraut
Person Completing This Certification Form
Robert Kraut COO
Printed Name and Title of Offrcer
Jan 31 ,2022
Date
2083264331
Contact Phone Number
M:(c+K)N = (D+F+I)O = M/I{*lfi)
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscrlbers ETC is
responslble for recerfi fying
Percent of subscribers due for
recertilicadon who were de-enrolled
0 9 0.0%
5
Affiliated ETCs
SAC Name
6