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Home My WebLink About20230127Potlatch Telephone Co. Form 555.pdfJanuary 26, 2023 Via E-Mail: secretary@puc.idaho.gov Ms. Jan Norijuki Commission Secretary Idaho Public Utilities Commission 472 W. Washington St. Boise, ID 83720-5983 RE: Case # GNR-T-23-01 FCC Form 555 Annual Lifeline Eligible Telecommunications Carrier Certification Form for TDS Telecom Dear Secretary Norijuki: Attached please find a copy of TDS Telecommunications LLC’s (“TDS Telecom”) Annual Lifeline Eligible Telecommunications Carrier Certification Form (FCC Form 555) which was filed with the Universal Service Administrative Company (“USAC”) on January 25, 2023. TDS’ FCC Form 555 included the Affiliated SACs in our filing with USAC. Due to a USAC system issue, the affiliate information does not appear in the certified forms. We are attaching the affiliate information with a copy of our certified Form 555 for this state notification. If you have any questions concerning this matter or regarding the attached information, please contact me at 608-664-2415 or via e-mail at nicole.mauritz@tdstelecom.com. Sincerely, Nicole Mauritz Regulatory Compliance Manager Attachments cc: Gail Long Nez Perce Tribe RECEIVED Friday, January 27, 2023 10:41:46 AM IDAHO PUBLIC UTILITIES COMMISSION 1 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 IMPORTANT: PLEASE READ INSTRUCTIONS FIRST Deadline: January 31st (Annually) Study Area Code (SAC) Service Provider Identification Number (SPIN) (An Eligible Telecommunications Carrier (ETC) must provide a certification form for each SAC through which it provides Lifeline service). (If same as ETC name, list “N/A” Do not leave blank) (If same as ETC name, list “N/A” Do not leave blank) Does the reporting company have affiliated ETCs? Provide a list of all ETCs that are affiliated with the reporting ETC, using page 4 and additional sheets if necessary. Affiliation shall be determined in accordance with Section 3(2) of the Communications Act. That Section defines “affiliate” 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. § 153(2). See also 47 C.F.R. § 76.1200. Affiliated ETC’s SAC Affiliated ETC’s Name -- See attached worksheet -- Telephone and Data Systems, Inc. ID 143002520 Potlatch Telephone Company Inc N/A 2022 472230 2 ETCs Subject to the Non-Usage Requirements All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthly fee from their Lifeline subscribers are subject to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number of subscribers de-enrolled by month in Section 4. ETCs that only assess a fee but do not collect such fees 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 No If yes, record the number of subscribers de-enrolled for non-usage by month in Block Q below. P Q Month Subscribers De-Enrolled for Non-Usage January February March April May June July August September October November December Total Subscribers 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 by-laws (or partnership 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 sign the certification. Initial Certification All ETCs must complete this section 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 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. Initial _________ 0 0 0 0 0 SVT 0 0 0 0 0 0 0 0 3 Annual Recertification Do not leave empty blocks. If an ETC has nothing to report in a block, en ter a zero. Report the number of Lifeline subscribers due for recertification by month (January-December) A.Subscribers eligible for recertification by anniversary month B.Subscribers de-enrolled prior to recertification attemptsC.Total number of subscribers ETC is responsible for recertifying (A-B) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Total A. B. C. Recertification Methods State of federal database D.Subscribers recertified through ETC access to state or federal database by anniversary month Report the number of eligible subscribers verified through access to a state or federal database. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Total D. E.Name of the data source(s) used to verify consumer eligibility: __________________________________________________________________ ETC Direct Contact F.Subscribers contacted by ETC directly to recertify (You may also use this section to report subscriber initiated recertifications). Report the number of Lifeline subscribers the ETC contacted directly to obtain recertification of eligibility Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Total F. G.Subscribers who failed to recertify through ETC direct outreach attempt Report the number of Lifeline subscribers de-enrolled due to ineligibility or non-response to the ETC’s outreach attempt. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Total G. 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 4 H.Subscribers who recertified through ETC direct outreach attempt Report the number of Lifeline subscribers that successfully recertified through ETC’s outreach attempt. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Total H. Third Party I.Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC Report the number of Lifeline subscribers contacted by a state administrator, third party administrator, or USAC for the purpose of recertification. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Total I. J.Name of third party administrator used to verify subscriber eligibility: ____________________________________________________________ K.Subscribers de-enrolled as a result of a third party recertification attempt Report the number of subscribers as a result of ineligibility or non-response to outreach from a state administrator, third party administrator, or USAC. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Total K. L.Subscribers who recertified through a state administrator, third party administrator, or USAC’s recertification effort Report the number of subscribers that recertified through a request from a state administrator, third party administrator, or USAC Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Total L. Certification: Recertification Method: Database I certify 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 _________ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 00 0 0 0 0 0 0 0 0 0 0 5 Recertification Method: ETC I certify 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. 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 certification for the SAC(s) listed above. Initial _________ No Subscribers I certify 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 _________ M = (G+K) N = (D+F+I) O = M/N*100 Total number of subscribers de-enrolled as a result of recertification Total number of subscribers ETC is responsible for recertifying Percent of subscribers due for recertification who were de-enrolled 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, Signature of Officer Email Address of Officer Person Completing This Certification Form Printed Name and Title of Officer Date Contact Phone Number Sharon V Tisdale Assistant Treasurer 0 0 Jan 25, 2023 Sharon V Tisdale Assistant Treasurer Nicole Mauritz 0.0% 6086642415 Sharon.tisdale@tdsinc.com 6 Affiliated ETCs SAC Name Attachment - TDS Telecommunications LLC Affiliates SAC Name SAC Name 100005 Cobbosseecontee Telephone Company Island Telephone Company 100007 The Island Telephone Company Chatham Telephone Company 100010 Hampden Telephone Company Shiawassee Telephone Company 100011 Hartland & St. Albans Telephone Company Wolverine Telephone Company 100024 Somerset Telephone Company Camden Telephone Company, Inc. 100031 Warren Telephone Company Communications Corporation of Indiana 100034 The West Penobscot Telephone and Telegraph Company The Home Telephone Company of Pittsboro, Inc. 109002 U.S. Cellular Home Telephone Company, Inc. 120045 Kearsarge Telephone Company The Merchants and Farmers Telephone Company 120047 Merrimack County Telephone Company Communications Corporation of Southern Indiana 120049 Union Telephone Company S & W Telephone Company, Inc. 120050 Wilton Telephone Company, Inc. Tipton Telephone Company, Inc. 123321 Hollis Telephone Company, Inc. Tri-County Communications Corporation 129002 NH #1 Rural Cellular, Inc. (U.S. Cellular) West Point Telephone Company 140058 Ludlow Telephone Company Badger Telecom, LLC 140061 Northfield Telephone Company Black Earth Telephone Company, LLC. 140062 Perkinsville Telephone Company, Inc. Bonduel Telephone Company, LLC. 150089 Deposit Telephone Company, Inc. Burlington, Brighton & Wheatland Telephone Company, LLC 150092 Edwards Telephone Company, Inc. Central State Telephone Company, LLC 150114 Oriskany Falls Telephone Corporation Dickeyville Telephone, LLC 150118 Port Byron Telephone Company The Farmers Telephone Company, LLC 150129 Township Telephone Company, Inc. Mid-Plains Telephone, LLC 150133 Vernon Telephone Company, Inc. Midway Telephone Company, LLC 170183 Mahanoy & Mahantango Telephone Company EastCoast Telecom of Wisconsin, LLC 170206 Sugar Valley Telephone Company Mosinee Telehphone Company 190217 Amelia Telephone Corporation Mt. Vernon Telephone Company, LLC 190253 Virginia Telephone Company Grantland Telecom, LLC 193029 New Castle Telephone Co. Riverside Telecom, LLC 209005 Hardy Cellular Telephone Company (U.S. Cellular) Scandinavia Telephone Company, LLC 210338 Quincy Telephone Company (FL) Southeast Telephone Co. of Wisconsin, LLC 220338 Quincy Telephone Company (GA) Stockbridge & Sherwood Telephone Company, LLC 220346 Blue Ridge Telephone Company State Long Distance Telephone Company 220351 Camden Telephone and Telegraph Company, Inc. Tenney Telephone Company, LLC 220375 Nelson-Ball Ground Telephone Company Utelco, LLC. 239006 Wilmington Cellular Telephone Company Waunakee Telephone Company, LLC. 240533 McClellanville Telephone Company, Inc. 240535 Norway Telephone Co. Inc 240544 St. Stephen Telephone Company Arvig Telephone Company 240551 Williston Telephone Company Bridge Water Telephone Co. 250284 Butler Telephone Company, Inc. KMP d/b/a Mid-State Telephone Company 250311 Oakman Telephone Company, Inc. Mid-State Telephone Company 250314 Peoples Telephone Company, Inc. Winsted Telephone Company Attachment - TDS Telecommunications LLC Affiliates 260411 Leslie County Telephone Company Oklahoma Communication Systems, Inc. 260412 Lewisport Telephone Co. Mid-America Telephone, Inc. 260417 Salem Telephone Co. Arizona Telephone Company 280448 Calhoun City Telephone Company, Inc. Southwestern Telephone Company 283301 Southeast Mississippi Telephone Company, Inc. Delta County Tele-Comm, Inc. 287449 Myrtle Telephone Company, Inc. Strasburg Telephone Company 290559 Concord Telephone Exchange, Inc Potlatch Telephone Company, Inc. 290566 Humphreys County Telephone Company Asotin Telephone Company (WA) 290575 Tennessee Telephone Company Lewis River Telephone Company, Inc. 290578 Tellico Telephone Company, Inc. McDaniel Telephone Company 299010 United States Cellular Operating Company of Knoxville 300585 Arcadia Telephone Company Asotin Telephone Company (OR) 300607 Continental Telephone Company 300613 Little Miami Communications Corporation Happy Valley Telephone Company 300645 Oakwood Telephone Company Hornitos Telephone Company 300662 The Vanlue Telephone Company Winterhaven Telephone Company 310672 Communications Corporation of Michigan