Form FCC 508 FCC 508 Projected Annual Common Line Revenue Requirement

Competitive Carrier Line Count Report and Self-Certification as a Rural Carrier, FCC Forms 481, 507, 508, 509, and 525

Copy of 508 Form.xls

Competitive Carrier Line Count Report and Self-Certification as a Rural Carrier, FCC Forms 525 and 481

OMB: 3060-0986

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Overview

PROJ. ANN. COMMON LINE REV REQ.
CORRECTIONS TO PROJECTION
508 CERT.-REPORTING CARRIER
508 CERTIFICATION-AGENT
508 NOTICE


Sheet 1: PROJ. ANN. COMMON LINE REV REQ.

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
2 Carrier Study Area Name alpha characters
3 Service Provider Identification Number 9 numeric digits
4 Data Period (specify years) 07/01/20yy - 06/30/20yy
5 Date of Submission mm/dd/yyyy
6 Contact Name alpha characters
7 Contact Telephone Number [including area code] 10 numeric digits
8 Contact E-mail Address alpha/numeric characters
Block 2 - Projected Annual Common Line Revenue Requirement by Study Area
9 Projected Common Line Revenue Requirement (July 1-June 30) amount in $
10 Projected SLC Revenues (July 1-June 30) amount in $
11 Projected Special Access Surcharges (July 1-June 30) amount in $
12 Projected Line Port Costs in Excess of Basic Analog Service (July 1-June 30) amount in $
13 Projected LTS (July 1-June 30) amount in $

Sheet 2: CORRECTIONS TO PROJECTION

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
2 Carrier Study Area Name alpha characters
3 Service Provider Identification Number 9 numeric digits
4 Data Period (specify years) 07/01/20yy - 06/30/20yy
5 Date of Correction mm/dd/yyyy
6 Contact Name alpha characters
7 Contact Telephone Number [including area code] 10 numeric digits
8 Contact E-mail Address alpha/numeric characters
Block 2 - Projected Annual Common Line Revenue Requirement by Study Area
9 Projected Common Line Revenue Requirement (July 1-June 30) amount in $
10 Projected SLC Revenues (July 1-June 30) amount in $
11 Projected Special Access Surcharges (July 1-June 30) amount in $
12 Projected Line Port Costs in Excess of Basic Analog Service (July 1-June 30) amount in $
13 Projected LTS (July 1-June 30) amount in $

Sheet 3: 508 CERT.-REPORTING CARRIER

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING FCC FORM 508 ON ITS OWN BEHALF:


























































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














































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

Filing Due Date for this form (mm/dd/yyyy)





Sheet 4: 508 CERTIFICATION-AGENT

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING FCC FORM 508 ON THE CARRIER'S BEHALF:













































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

















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

Filing Due Date for this form (mm/dd/yyyy)



TO BE COMPLETED BY THE AUTHORIZED AGENT:













































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































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

Filing Due Date for this form (mm/dd/yyyy)



Sheet 5: 508 NOTICE















File Typeapplication/vnd.ms-excel
File TitleICLS Year 2 Form 508
SubjectOTHR
Last Modified ByNicole Ongele
File Modified2016-04-25
File Created2002-05-06

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