20250110Rural Telephone Co. Inc Form 555.pdf

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RECEIVED
2025 January 10
IDAHO PUBLIC
7M UTILITIES COMMISSION
RURAL TELECOM eel w. Madison Ave.,Gienns Ferry,lO e3623
Idaho PUC
11331 W Chinden Blvd
Building 8 Ste 201-A
Boise I D 83714
January 10, 2025
Dear Idaho PUC;
Filing copy of FCC 555 form for informational purposes. Our counties include Elmore, Lemhi and
Owyhee.
Sincerely,
Theresa Wilson, Billing Manager
RTI Telephone Company
892 W Madison Ave
Glenns Ferry ID 83623
208-366-2614
Theresa.wilson ruraltel.org

Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers s o gmust complete all r 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)
472233 143002523
Study Area Code(SAC) Service Provider Identification Number(SPIN)
(An Eligible Telecommunications Carrier(ETC)must provide a Certification form for each SAC that provides Lifeline service).
2024 ID Rural Telephone Company
Recertification Year State ETC Name
RURAL TELEPHONE COMPANY
DBA, Marketing,or Other Branding Name Holding Company Name
(!!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? Yes_No X
Provide a list of all ETCs that are atTllated 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 afirilate"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
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Initial Certification All ETCs must complete this section,
I certify that the company listed above:
• Has policies and procedures in place to ensure that its Lifeline subscribers are eligible to receive Lifeline
services; and
• Is in compliance with all federal Lifeline certification procedures; and
• Is in compliance with the minimum service levels set forth in 47 C.F.R. § 54.408,
1 am an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial MRM
Annual Recertification Results
Report the results of recertification efforts for the current calendar year.
Do not leave blocks empty.if the National Verifier is responsible for conducting recertification,enter zero for blocks A-F.If the state Lifeline
Administrator is responsible for conducting recertification,report the results for each block.
A. Subscribers eligible for recertification within current calendar year
B. Subscribers de-enrolled prior to recertification attempts
C.Total number of subscribers required to be recertified (A-B)
D. Subscribers successfully recertified
E. Subscribers de-enrolled for failed recertification
F. Percentage de-enrolled for failed recertification (E/C)
I certify that the company listed above has procedures in place to recertify consumer eligibility by relying upon
notice of eligibility from: —state Lifeline administrator X National Verifier
I am an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial MRM
No Subscribers Certification Complete this section If ETC claimed no Lifeline subscribers.
certify that my company did not claim federal low Income support for the current Form 555 data year.1 am an officer of the company named above.I
am authorized to make this certification for the SAC(s)listed on this form
Initial MRM
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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.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 do-enrolled by
month.
Is the ETC subject to the non-usage requirements?Yes`NO X
If yes,record the number of subscribers de-enrolled for non-usage by month In Block H below.
G H
Month Subscribers De-Enrolled for Non-Usage
January
February
March
April
May
June
July J'
August 1
September j
October
November
December
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, j
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.
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Signature Block
By signing below, I certify that the information provided is true and accurate. I am an officer of the company named
above. I am authorized to make this certification for this SAC.
Signed,
Mark Martell Mark Martell-Admin.Manager
Signature of Officer Printed Name and Title of Officer
[e-mail] 01-10-2025
Email Address of Officer Date
Theresa Wilson 2083662614
Person Completing This Certification Form Contact Phone Number
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