PROJECTED ANNUAL COMMON LINE REVENUE REQUIREMENT |
Block 1 - Contact Information |
ROW # |
DATA ELEMENT |
FORMAT OF REQUESTED DATA |
RESPONSE |
1 |
Carrier Study Area Code |
6 numeric digits |
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2 |
Carrier Study Area Name |
alpha characters |
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3 |
Service Provider Identification Number |
9 numeric digits |
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4 |
Data Period (specify years) |
07/01/20yy - 06/30/20yy |
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5 |
Date of Submission |
mm/dd/yyyy |
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6 |
Contact Name |
alpha characters |
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7 |
Contact Telephone Number [including area code] |
10 numeric digits |
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8 |
Contact E-mail Address |
alpha/numeric characters |
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Block 2 - Projected Annual Common Line Revenue Requirement by Study Area |
9 |
Projected Common Line Revenue Requirement (July 1-June 30) |
amount in $ |
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10 |
Projected SLC Revenues (July 1-June 30) |
amount in $ |
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11 |
Projected Special Access Surcharges (July 1-June 30) |
amount in $ |
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12 |
Projected Line Port Costs in Excess of Basic Analog Service (July 1-June 30) |
amount in $ |
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13 |
Projected LTS (July 1-June 30) |
amount in $ |
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CORRECTIONS PROJECTED ANNUAL COMMON LINE REVENUE REQUIREMENT |
Block 1 - Contact Information |
ROW # |
DATA ELEMENT |
FORMAT OF REQUESTED DATA |
RESPONSE |
1 |
Carrier Study Area Code |
6 numeric digits |
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2 |
Carrier Study Area Name |
alpha characters |
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3 |
Service Provider Identification Number |
9 numeric digits |
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4 |
Data Period (specify years) |
07/01/20yy - 06/30/20yy |
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5 |
Date of Correction |
mm/dd/yyyy |
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6 |
Contact Name |
alpha characters |
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7 |
Contact Telephone Number [including area code] |
10 numeric digits |
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8 |
Contact E-mail Address |
alpha/numeric characters |
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Block 2 - Projected Annual Common Line Revenue Requirement by Study Area |
9 |
Projected Common Line Revenue Requirement (July 1-June 30) |
amount in $ |
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10 |
Projected SLC Revenues (July 1-June 30) |
amount in $ |
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11 |
Projected Special Access Surcharges (July 1-June 30) |
amount in $ |
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12 |
Projected Line Port Costs in Excess of Basic Analog Service (July 1-June 30) |
amount in $ |
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13 |
Projected LTS (July 1-June 30) |
amount in $ |
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TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING FCC FORM 508 ON ITS OWN BEHALF:
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Certification of Officer or Employee as to the Accuracy of the Data Reported in FCC Form 508, Interstate Common Line Support Mechanism Projected Annual Common Line Revenue Requirement Form, on Behalf of Reporting Carrier |
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Name of Reporting Carrier |
Signature of authorized officer or employee |
Date |
Printed name of authorized officer or employee |
Title or position of authorized officer or employee |
Telephone number of authorized officer or employee: ( _ _ _ ) _ _ _ - _ _ _ _, ext. _ _ _ _ _ |
Study Area Code of Reporting Carrier |
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Filing Due Date for this form (mm/dd/yyyy) |
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TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING FCC FORM 508 ON THE CARRIER'S BEHALF:
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Certification of Officer or Employee to Authorize an Agent to File FCC Form 508, Interstate Common Line Support Mechanism Projected Annual Common Line Revenue Requirement Form, on Behalf of Reporting Carrier |
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Name of Authorized Agent |
Name of Reporting Carrier |
Signature of authorized officer or employee |
Date |
Printed name of authorized officer or employee |
Title or position of authorized officer or employee |
Telephone number of authorized officer or employee: ( _ _ _ ) _ _ _ - _ _ _ _, ext. _ _ _ _ _ |
Study Area Code of Reporting Carrier |
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Filing Due Date for this form (mm/dd/yyyy) |
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TO BE COMPLETED BY THE AUTHORIZED AGENT: |
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Certification of Agent Authorized to File FCC Form 508, Interstate Common Line Support Mechanism Projected Annual Common Line Revenue Requirement Form, on Behalf of Reporting Carrier |
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Name of Reporting Carrier |
Name of Authorized Agent |
Signature of authorized agent or employee of agent |
Date |
Printed name of authorized agent or employee of agent |
Title or position of authorized agent or employee of agent |
Telephone number of authorized agent: ( _ _ _ ) _ _ _ - _ _ _ _, ext. _ _ _ _ _ |
Study Area Code of Reporting Carrier |
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Filing Due Date for this form (mm/dd/yyyy) |
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