FCC Forms 555 and 481

Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016
Instructions for Completing
54.313 / 54.422 Data Collection Form
*****
NOTICE: All eligible telecommunications carriers (ETCs) requesting federal high-cost or low-income
universal service support from the Universal Service Administrative Company, the universal service
Administrator, shall file this financial and operations information on an annual basis. This collection of
information stems from the Commission's authority under section 254 of the Communications Act of 1934, as
amended, 47 U.S.C. § 254, and from sections 54.313 and 54.422 of the Commission’s rules, 47 C.F.R. §§
54.313 and 54.422. The data in the form will be used to validate the recipient companies’ support, if any, that
it is eligible to receive from the high-cost support mechanism and / or the Lifeline and Link Up support
mechanism.
USAC estimates that each response to this collection of information will take, on average, 20 hours for a highcost recipient, and 3 hours for a Lifeline-only recipient. USAC’s estimate includes the time to read the
instructions, look through existing records, gather and maintain the required data, and actually complete and
review the form or response. If you have any comments on this estimate, or how we can improve the
collection and reduce the burden it causes you, please write to the Federal Communications Commission,
AMD-PERM, Paperwork Reduction Project (3060-0986), Washington, D.C. 20554. We also will accept your
comments via the Internet if you send them to Nicole.Ongele@fcc.gov. Please DO NOT SEND COMPLETED
DATA COLLECTION FORMS TO THIS ADDRESS.
Remember – You are not required to respond to a collection of information sponsored by the Federal
government, and the government may not conduct or sponsor this collection, unless it displays a currently
valid Office of Management and Budget (OMB) control number. This collection has been assigned an OMB
control number of 3060-0986 for high-cost recipients and 3060-0819 for low-income recipients.
The Commission is authorized under the Communications Act of 1934, as amended, to collect the information
requested in this form. Provided information will be used to determine high-cost support mechanism and
Lifeline support mechanism amounts. If USAC believes there may be a violation or potential violation of a
statute or a Commission regulation, rule, or order, your form may be referred to the Federal, state, or local
agency responsible for investigating, prosecuting, enforcing, or implementing the statute, rule, regulation, or
order. In certain cases, the information in your form may be disclosed to the Department of Justice, court, or
other adjudicative body when (a) the Commission; (b) any employee of the Commission; or (c) the United
States government, is a party to a proceeding before the body or has an interest in the proceeding.
If you do not provide the information we request on this form, you are not eligible to receive support under the
high-cost and/or Lifeline support mechanisms, 47 C.F.R. Parts D and E.
The foregoing Notice is required by the Paperwork Reduction Act of 1995, P.L. No. 104-13, 44 U.S.C. § 3501,
et seq.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Specific Instructions
I. Introduction and Background
Eligible telecommunications carriers (ETCs) that receive federal high-cost universal service
support (high-cost support) are required to provide the data identified in 47 C.F.R. § 54.313. 1
Beginning with the filing due on July 1, 2016, participants in rural broadband experiments (RBE)
should file this form. Submission of an FCC Form 481 is not required for recipients who solely
receive support from Phase I of the Mobility Fund as indicated in 47 C.F.R. § 54.313(k).
Lifeline-only ETCs that receive only low-income support through the federal Lifeline program
(low-income support) are required to provide the data identified in 47 C.F.R. § 54.422. 2
ETCs that receive both high-cost support and low-income support should follow the high-cost
and low-income support requirements. ETCs that receive only low-income support should
follow only the low-income support requirements. These annual reports are intended to assure
compliance with the Federal Communications Commission’s (FCC) rules and progress toward
its universal service goals.
II. The Carrier or the Carrier’s Agent May File This Form
As an ETC, you may choose to complete this filing directly and submit it to the FCC, the
Universal Service Administrative Company (USAC), the universal service Administrator, and
the relevant state commissions, relevant authority in a U.S. Territory, or Tribal governments, as
appropriate. Alternatively, you can elect to designate an agent to execute the compliance filing
on your behalf and submit it to the FCC, USAC, and the relevant state commissions, relevant
authority in a U.S. Territory, or Tribal governments, as appropriate. Please note that, if you
choose to designate an agent to complete and submit FCC Form 481 on your behalf, an
authorized officer of your company must advise USAC of the identity of your agent, and certify
that the actual data provided to your authorized agent is accurate to the best of his/her
knowledge. Your authorized agent must:
1. Certify that he/she is authorized to submit the information on behalf of the reporting
ETC;
2. Certify that the data provided on the form are based on actual operational data received
from the reporting ETC;
1

See Connect America Fund et al., WC Docket Nos. 10-90, et al., Report and Order and Further Notice of Proposed
Rulemaking, 26 FCC Rcd 17663 (2011) (USF/ICC Transformation Order) (adopting section 54.313 of the
Commission’s rules).

2

See Lifeline and Link Up Reform and Modernization et al., WC Docket No.11-42, et al., Report and Order and
Further Notice of Proposed Rulemaking, 27 FCC Rcd 6656 (2012) (Lifeline Reform Order) (adopting section 54.422
of the Commission’s rules).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

3. Certify that the information on the form is accurate to the best of the agent’s knowledge;
and
4. Provide copies of the compliance filing to the reporting ETC within 15 days.
Certifications are subject to the penalties for false statements imposed under 18 U.S.C. § 1001. 3
III. When Must ETCs Make These Compliance Filings
a. Reporting Requirements for High-Cost Recipients
•

Section 54.313 requires all ETCs receiving high-cost support to file annual reports
regarding compliance with the Commission’s rules and progress toward its universal
service goals. 4 This section does not apply to ETCs that only receive Mobility Fund
Phase I support, who must file annual reports, FCC Form 690, pursuant to section
54.1009. 5

•

Section 54.313 annual reports are due annually on July 1st each year. 6

•

ETCs must file with the Office of the Secretary of the FCC, clearly referencing WC
Docket No. 14-58, and with USAC, and send copies to the relevant state commission,
relevant authority in a U.S. Territory, or Tribal government, as appropriate. 7 See
section IV below for specific filing instructions.

•

Any new reporting requirements are not effective until Federal Register publication
of approval by the Office of Management and Budget.

•

ETCs receiving high-cost support for voice telephony service and offering broadband
as a condition of receiving such support must report with respect to broadband service
offered by the ETC directly to end-user customers and/or an Internet service provider
that provides retail broadband Internet access service to end-user customers in
satisfaction of the ETC’s broadband obligations.

•

Sections 54.313(a)(2)-(4) require ETCs annually to file information concerning
outages, unfulfilled service requests, and complaints. 8 ETCs must separately file

3

See USF/ICC Transformation Order, 26 FCC Rcd at 17853, para. 581.

4

See 47 C.F.R. § 54.313.

5

47 C.F.R. § 54.313(k). Recipients that solely receive support from the Phase I Mobility Fund are subject to the
reporting requirements in section 54.1009, which is collected pursuant to a different OMB-approved information
collection.

6

47 C.F.R. § 54.313(j); see also Connect America Fund et al., WC Docket No. 10-90 et al., Third Order on
Reconsideration, 27 FCC Rcd 5622, 5626, para. 10 (2012) (Third Reconsideration Order) (revising the filing
deadline to July 1).
7

47 C.F.R. § 54.313(i).

8

47 C.F.R. § 54.313(a)(2) through (a)(4).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

these data for voice and broadband service, 9 except that, at this time, ETCs are not
required to submit outage information regarding their broadband service. 10
•

Sections 54.313(a)(5)-(6) require ETCs to make certifications as to their compliance
with applicable service quality standards and consumer protection rules, and their
ability to remain functional in emergency situations as set forth in section
54.202(a)(2). 11 ETCs must separately file these data for voice and broadband
service. 12

•

Section 54.313(a)(7) requires ETCs to report their voice price offerings and
broadband price offerings. 13 ETCs should report rates in effect as of January 1 of the
reporting year.

•

Section 54.313(a)(8) requires ETCs, beginning July 1, 2013, and annually thereafter,
to report ownership information. 14

•

Section 54.313(a)(9) requires ETCs, to the extent they serve Tribal lands, to
undertake their Tribal engagement obligations pursuant to the Office of Native
Affairs and Policy (ONAP) guidance. 15

•

Section 54.313(a)(10) requires ETCs to certify that the pricing of their voice services
are no more than two standard deviations above the applicable national average urban

9

47 C.F.R. § 54.313(a) (requiring ETCs to separately break out for voice and broadband information and data
required in section 54.313(a)(1) through (a)(7)); see also ETC Reporting Clarification Order, 28 FCC Rcd at 2056,
para. 14 (revising section 54.313).

10

See The Proposed Extension of Part 4 of the Commission’s Rules Regarding Outage Reporting To Interconnected
Voice Over Internet Protocol Service Providers and Broadband Internet Service Providers, PS Docket No. 11-82,
Report and Order, 27 FCC Rcd 2650 (2012) (deferring action on possible performance degradation thresholds for
measuring an outage of broadband Internet service).
11

47 C.F.R. § 54.313(a)(5), (6); see also 47 C.F.R. § 54.202(a)(2).

12

47 C.F.R. § 54.313(a) (requiring ETCs to separately break out for voice and broadband information and data
required in section 54.313(a)(1) through (a)(7)); see also ETC Reporting Clarification Order, 28 FCC Rcd at 2056,
para. 14 (revising section 54.313); Rate-of-Return Five-Year Plan Waiver Order, 28 FCC Rcd at 7228-29, paras. 6-7
(clarifying rate-of-return carriers’ broadband-related information reporting obligations).
13
14

47 C.F.R. § 54.313(a)(7).
47 C.F.R. § 54.313(a)(8).

15

47 C.F.R. § 54.313(a)(9); see also Office of Native Affairs and Policy, Wireless Telecommunications Bureau, and
Wireline Telecommunications Bureau Issue Further Guidance on Tribal Government Engagement Obligation
Provisions of the Connect America Fund, WC Docket Nos. 10-90 et al., 27 FCC Rcd 8176 (2012).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

rate for voice service, which will be specified annually in a public notice issued by
the FCC’s Wireline Competition Bureau. 16

16
17
18
19
20

•

Section 54.313(a)(11) requires ETCs to submit the results of network performance
tests pursuant to the methodology and in the format determined by the Commission’s
Wireline Competition Bureau, Wireless Telecommunications Bureau, and Office of
Engineering and Technology. 17 At this time, ETCs are not required to submit any
information pursuant to this section.

•

Section 54.313(a)(12) requires ETCs to certify that the pricing of one of their
broadband services, which meet public interest obligations, is no more than the
applicable benchmark announced annually in a public notice issued by the FCC’s
Wireline Competition Bureau or is no more than the non-promotional price charged
for a comparable fixed wireline service in urban areas in the states of U.S. Territories
where the eligible telecommunications carrier receives support. 18

•

Section 54.313(b) requires any recipient of incremental Connect America Phase I
support pursuant to section 54.312(b)&(c) to provide certain certifications and other
details related to their broadband obligations. 19

•

Section 54.313(c) requires price cap ETCs that receive frozen high-cost support
pursuant to section 54.312(a) to provide certain annual certifications related to their
broadband obligations. 20

•

Section 54.313(d) requires price cap ETCs that receive high-cost support to offset
reductions in access charges to provide certain certifications related to their
broadband obligations. 21

•

Section 54.313(e) requires recipients of Connect America Phase II support to provide
certain certifications and other details related to their broadband obligations. 22

•

Section 54.313(f) requires rate-of-return ETCs to provide certain certifications and
other details related to their broadband obligations. 23

47 C.F.R. § 54.313(a)(10).
47 C.F.R. § 54.313(a)(11).
47 C.F.R. § 54.313(a)(12).
47 C.F.R. § 54.313(b); see also 47 C.F.R. § 54.312(b).
47 C.F.R. § 54.313(c); see also 47 C.F.R. § 54.312(a).

21

47 C.F.R. § 54.313(d); see also 47 C.F.R. § 54.304; USF/ICC Transformation Order, 26 FCC Rcd at 17994-95,
para. 918.

22

47 C.F.R. § 54.313(e).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

•

Section 54.313(f)(2) requires privately held rate-of-return ETCs, beginning in July 1,
2013, and annually thereafter, to file financial reports. 24
o Privately held rate-of-return ETCs that receive loans from the Rural Utilities
Service (RUS) must file electronic copies of their annual RUS reports (Operating
Report for Telecommunications Borrowers).
o All privately held rate-of-return ETCs that are not recipients of loans from the
RUS and whose financial statements are audited in the ordinary course of
business must provide either: (1) a copy of their audited financial statement; or
(2) a financial report in a format comparable to RUS Operating Report for
Telecommunications Borrowers, accompanied by a copy of a management letter
and/or audit opinion issued by the independent certified public accountant that
performed the company’s financial audit.
o All other privately held rate-of-return ETCs must provide either: (1) a copy of
their financial statement which has been subject to review by an independent
certified public accountant; or (2) a financial report in a format comparable to
RUS Operating Report for Telecommunications Borrowers, with the underlying
information subjected to a review by an independent certified public accountant
and accompanied by an officer certification that: (a) the carrier was not audited in
the ordinary course of business for the preceding fiscal year; and (b) that the
reported data are accurate.

23

•

Section 54.313(g) requires ETCs without access to terrestrial backhaul to certify they
offer broadband service of at least 1 Mbps/256 kbps within the supported area served
by satellite middle-mile facilities.

•

Section 54.313(h) requires all incumbent local exchange carriers receiving high-cost
support to report all of their rates for residential local service for all portions of their
service area, as well as state fees, to the extent the sum of those rates and fees are
below the rate floor, and the number of lines for each rate specified. 25 ETCs shall
report lines and rates in effect as of June 1 of the reporting year. For these purposes,
state regulated fees are limited to state subscriber line charges, state universal service
fees and mandatory extended area service charges. Federal subscriber line charges
and federal universal service fees are not included. In addition to the annual filing,
local exchange carriers may file updates of their rates for residential local service, as

47 C.F.R. § 54.313(f).

24

47 C.F.R. § 54.313(f)(2); see also Connect America Fund et al., WC Docket No. 10-90 et al., Fifth Order on
Reconsideration, 27 FCC Rcd 14549, paras. 6-11 (2012) (Fifth Reconsideration Order) (revising financial reporting
requirement for privately held rate-of-return carriers).

25

47 C.F.R. § 54.313(h); see also Connect America Fund et al., WC Docket No. 10-90 et al., Third Order on
Reconsideration, 27 FCC Rcd 5622, 5629-31, paras. 18-22 (2012) (Third Reconsideration Order) (revising the
filing deadline for rates, permitting mid-year updates, and clarifying how carriers should calculate rates).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

well as state fees, on January 2 of each year. If a local exchange carrier reduces its
rates and the sum of the reduced rates and state fees are below the rate floor, the local
exchange carrier shall file such an update. For the update, carriers shall report lines
and rates in effect as of December 1.
o ETCs subject to section 54.313(h) should file separately with USAC their rates
and line counts on the Rate Floor Data Collection form.
b. Reporting Requirements for Low-Income Recipients
•

Section 54.422 requires ETCs receiving low-income support (as per subpart E of the
rules) to file annual reports reporting and certifying to certain information. 26

•

Section 54.422 annual reports are due annually on July 1st each year.

•

ETCs must file with the Office of the Secretary of the Commission and with the
Administrator, and send copies to the relevant state commission, relevant authority in
a U.S. Territory, or Tribal government, as appropriate. 27

•

Section 54.422(a)(1) requires all such ETCs to report ownership information. 28

•

Section 54.422(a)(2) requires all such ETCs to report the terms and conditions of any
voice telephony service plans offered to Lifeline subscribers. 29

•

Section 54.422(b) requires ETCs designated by the FCC under section 214(e)(6) of
the Act that receive only low-income support and do not receive high-cost support to
file the following information {previously filed for section 54.209 compliance}: 30
i. Information regarding service outages,
ii. Number of complaints received per 1,000 connections,
iii. Certification of compliance with applicable minimum service standards
iv. Certification that the carrier is able to function in emergency situations.

IV. Filing Instructions
As an ETC, you must file this form with the FCC, USAC (the universal service Administrator),
and the relevant state commission, relevant authority in a U.S. Territory, or Tribal governments,
as appropriate.
26
27
28
29

47 C.F.R. § 54.422.
47 C.F.R. § 54.422(c).
47 C.F.R. § 54.422(a)(1).
47 C.F.R. § 54.422(a)(2).

30

47 C.F.R. § 54.422(b). ETCs that receive both high-cost support and low-income support report this information
pursuant to section 54.313.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Applicants must complete and submit the FCC Form 481 online with USAC. Applicants are
required to complete and submit all forms online through USAC’s “E-File” portal at
https://forms.universalservice.org/usaclogin/login.asp. A Form 481 is required to be submitted
through this link. To create an online E-File account, please refer to the instructions on
http://www.usac.org/about/tools/e-file.aspx. Instructions on how to file electronically are also
found at USAC’s High Cost Forms website at http://www.usac.org/hc/tools/forms.aspx
Applicants without adequate Internet access to submit the forms online should contact USAC’s
High Cost Division (HC) (1-(888) 641-8722 or HCquestions@usac.org) to make alternative
arrangements.
Subsequent to ETCs completing this form online at www.usac.org, they can print out the
completed form, which can then be submitted to the FCC via its Electronic Comment Filing
System (ECFS), http://apps.fcc.gov/ecfs/, and must clearly reference WC Docket No. 14-58.
Parties who choose to file by paper with the FCC must file an original and one copy of each
filing.


Filings can be sent by hand or messenger delivery, by commercial overnight courier, or
by first-class or overnight U.S. Postal Service mail. All filings must be addressed to the
Commission’s Secretary, Office of the Secretary, Federal Communications Commission.



All hand-delivered or messenger-delivered paper filings for the Commission’s Secretary
must be delivered to FCC Headquarters at 445 12th St., SW, Room TW-A325,
Washington, DC 20554. The filing hours are 8:00 a.m. to 7:00 p.m. All hand deliveries
must be held together with rubber bands or fasteners. Any envelopes and boxes must be
disposed of before entering the building.



Commercial overnight mail (other than U.S. Postal Service Express Mail and Priority
Mail) must be sent to 9300 East Hampton Drive, Capitol Heights, MD 20743.



U.S. Postal Service first-class, Express, and Priority mail must be addressed to 445 12th
Street, SW, Washington DC 20554.

Parties seeking confidential treatment of portions of their FCC Form 481 should file with the
FCC pursuant to section 0.459 of the FCC’s rules. 31
Parties should follow the local rules to file with their relevant state commission, relevant
authority in a U.S. Territory, or Tribal governments, as appropriate.

31

47 C.F.R. § 0.459. In the Fifth Reconsideration Order, the Commission permitted privately-held rate of return
carriers to seek confidential treatment of their financial information filed pursuant to section 54.313(f)(2). See Fifth
Reconsideration Order, 27 FCC Rcd at 14555-56, para. 17; Connect America Fund et al., WC Docket No. 10-90 et
al., Protective Order, 30 FCC Rcd 6322 (Wireline Comp. Bur. 2015) (Protective Order).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Attachments
When attaching a document to a specific line item on the form, carriers must use the following
naming convention: Study Area Code (SAC)/state/a description of the document and form’s line
number.
Carrier Contact Information
Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served.
Please be sure to file a separate form for each study area in which you serve. If you are an ETC
and do not know your SAC, please contact USAC’s Customer Service Center at 1-877-877-4925
for assistance.
Line 015 – Study Area Name: Provide the standard name used to identify your study area.
Typically, the name is the same as your company name.
Line 020 – Program Year: The upcoming calendar year.
Line 030 – Contact Name: Provide the name of the individual that prepared the data submission
for your company. Providing this information will assist in resolving any issues or questions that
may arise from the data submission.
Line 035 – Contact Phone Number: Provide the telephone number of the individual that
prepared the data submission for your company. Providing this information will assist in
resolving any issues or questions that may arise from the data submission.
Line 039 – Contact Email Address: Provide the email address of the individual that prepared the
data submission for your company. Providing this information will assist in resolving any issues
or questions that may arise from the data submission.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting for All Recipients of Either High-Cost or Lifeline Support – Service
Outage Reporting (200)
Filing Regulations: 47 C.F.R. § 54.313(a)(2); 47 C.F.R. § 54.422(b)(1)
Purpose: ETCs must report any service outage which occurred in the prior calendar year for
each service area in which you are designated an ETC for any facilities you own, operate, lease,
or otherwise utilize. It is deemed a reportable incident (as per 47 C.F.R. § 4.5) if it has a
duration of at least 30 minutes and impacts at least ten percent of the end users served in the
service area or 911 special facility. The data collected on this page should be consistent with the
data reported on the Network Outage Reporting System (NORS).
See http://www.fcc.gov/pshs/services/cip/nors/nors.html
Line 210 – Voice Telephony Service Outage Reporting: Please respond (yes or no) whether
there were any reportable voice service outages in the prior calendar year.
If your response to Line 210 is “yes” then complete Line 220.
{Each line with the worksheet should cover a single reportable service outage incident; if the
lines of data extend beyond the bottom of the worksheet, it will be found on a separate
attachment}
Line 220 – Column a – NORS Reference Number: Input the reference number associated with
the data, for this outage incident, reported on the Network Outage Reporting System.
Line 220 – Column b1 – Outage Start Date: Input the date (format: mm/dd/yyyy) of the onset of
the service outage.
Line 220 – Column b2 – Outage Start Time: Input the time (24 hour format: hh/mm) of the
onset of the service outage.
Line 220 – Column b3 – Outage End Date: Input the date (format: mm/dd/yyyy) of the end of
the service outage.
Line 220 – Column b4 – Outage End Time: Input the time (24 hour format: hh/mm) of the end
of the service outage.
Line 220 – Column c1 – Number of Customers Affected: Input the total number of customers
affected at any time during the service outage.
Line 220 – Column c2 – Total Number of Customers: Input the amount of the study area’s total
customer base.
Line 220 – Column d – 911 Facilities Affected (yes/no): Confirm whether this outage impacted
the 911 facilities’ functionality at any time during the service outage.
Line 220 – Column e – Service Outage Description: Select the services impacted by the service
outage. Select from the drop down box (check all that apply) from the following options: Wireline
(including cable) VoIP; Wireline (including cable) Voice (non-VoIP); Cellular; Voice Over LTE
(VoLTE), 911, E911 or NG911 Services only; and Other (limit the field to 50 characters at most)

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Line 220 – Column f – Did this Service Outage Affect Multiple Study Areas: Confirm (yes / no)
if this service outage affected multiple study areas.
Line 220 – Column g – Service Outage Resolution: Provide a brief description of the processes
used to resolve the service outage.
Line 220 – Column h – Preventative Procedures: Provide a brief description of the preventative
procedures implemented by the carrier to avoid the occurrence of a similar service outage in the
future.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting for All Recipients of High-Cost Support – Unfulfilled Service Requests
(300)
Filing Regulations: 47 C.F.R. § 54.313(a)(3)
Purpose: ETCs must report the quantity of voice telephony and broadband requests which were
un-fulfilled in the prior calendar year.
Please note that if you respond a given service is not offered (either voice or broadband)
then you will not see the relevant field below and it will be marked not applicable.
Line 300 – Unfulfilled Voice Telephony Service Requests: Note the quantity of requests for
voice telephony service from potential customers within your service areas that were un-fulfilled
in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(3), for each service area in which
you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize.
Line 310 – Unfulfilled Voice Telephony Service Requests Resolution: Attach a detailed
description of how you attempted to provide service to potential customers whose initial requests
for service were unfulfilled in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(3), for
each service area in which you are designated an ETC for any facilities you own, operate, lease,
or otherwise utilize. Your description of the resolution should provide no information which is
considered to be customer proprietary network information (CPNI); only the generic process
utilized should be delineated.
Line 320 – Unfulfilled Broadband Service Requests: Note the quantity of requests for broadband
service from potential end-user customers within your service areas that were un-fulfilled in the
prior calendar year, as defined in 47 C.F.R. § 54.313(a)(3), for each service area in which you
are designated an ETC for any facilities you own, operate, lease, or otherwise utilize.
Line 330 – Unfulfilled Broadband Service Requests Resolution: Attach a detailed description of
how you attempted to provide broadband service to potential end-user customers whose initial
requests for service were unfulfilled in the prior calendar year, as defined in 47 C.F.R. §
54.313(a)(3), for each service area in which you are designated an ETC for any facilities you
own, operate, lease, or otherwise utilize. Your description of the resolution should provide no
information which is considered to be CPNI; only the generic process utilized should be
delineated.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting for All Recipients of Either High-Cost or Lifeline Support – Complaints
per 1,000 Customers (400)
Filing Regulations: 47 C.F.R. § 54.313(a)(4); 47 C.F.R. § 54.422(b)(2)
Purpose: For the prior calendar year, ETCs must report the quantity of fixed and mobile voice
complaints as well as the quantity of fixed and mobile broadband complaints.
Please note that if your response to Line 400 indicates voice service is not offered (either
fixed voice or mobile voice) then you will not see the relevant fields below (Line 410 or Line
420). Likewise, if your response to Line 430 indicates broadband service is not offered
(either fixed broadband or mobile broadband) then you will not see the relevant fields
below (Line 440 or Line 450).
Line 400 – Number of Complaints per 1,000 Customers (Voice Telephony Service): Indicate
how you would like to report customer complaints (no voice, fixed voice, mobile voice, or both)
for voice telephony service in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(4) {for
High-cost Recipients} and 47 C.F.R. § 54.422(b)(2){for Low-income Only Recipients }, for
each service area in which you are designated an ETC for any facilities you own, operate, lease,
or otherwise utilize.
Line 410 – Number of Complaints per 1,000 Customers (Fixed Voice Telephony Service): Note
the quantity of fixed voice telephony service customer complaints in the prior calendar year, as
defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients} and 47 C.F.R. § 54.422(b)(2){for
Low-income Only Recipients }, for each service area in which you are designated an ETC for
any facilities you own, operate, lease, or otherwise utilize. Leave blank if not applicable.
Line 420 – Number of Complaints per 1,000 Customers (Mobile Voice Telephony Service):
Note the quantity of mobile voice telephony service customer complaints in the prior calendar
year, as defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients} and 47 C.F.R. §
54.422(b)(2){for Low-income Recipients }, for each service area in which you are designated an
ETC for any facilities you own, operate, lease, or otherwise utilize. Leave blank if not applicable.
Line 430 – Number of Complaints per 1,000 Customers (Broadband Service): Indicate how you
would like to report end-user customer complaints (no broadband, fixed broadband, mobile
broadband, or both) for broadband service in the prior calendar year, as defined in 47 C.F.R. §
54.313(a)(4) {for High-cost Recipients}, for each service area in which you are designated an
ETC for any facilities you own, operate, lease, or otherwise utilize.
Line 440 – Number of Complaints per 1,000 Customers (Fixed Broadband Service): Note the
quantity of fixed broadband service end-user customer complaints in the prior calendar year, as
defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients}, for each service area in which
you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize. Leave
blank if not applicable.
Line 450 – Number of Complaints per 1,000 Customers (Mobile Broadband Service): Note the
quantity of mobile broadband service end-user customer complaints in the prior calendar year, as
defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients}, for each service area in which
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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize. Leave
blank if not applicable.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting for All Recipients of Either High-Cost or Lifeline Support – Service
Quality Standards and Consumer Protection Rules (500)
Filing Regulations: 47 C.F.R. § 54.313(a)(5); 47 C.F.R. § 54.422(b)(3)
Purpose: ETCs must certify compliance with applicable service quality standards and consumer
protection rules.
Line 500 – Compliance with Service Quality Standards and Consumer Protection Certification:
Provide a response (yes or no) to certify your compliance with applicable service quality
standards and consumer protection rules, as required in 47 C.F.R. § 54.313(a)(5) {for High-cost
Recipients}.
Line 510 – Description of Compliance with Service Quality Standards and Consumer Protection:
Attach a detailed description of how you complied with the applicable service quality standards
and consumer protection rules, as required in 47 C.F.R. § 54.313(a)(5) {for High-cost
Recipients}.
Line 515 – Compliance with Minimum Service Standards: Provide a response (yes or no) to
certify your compliance with applicable minimum service standards, as required in 47 C.F.R. §
54.422(b)(3) {for Low-income Only Recipients}. Please note that this item is not applicable for
High-cost recipients.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting for All Recipients of Either High-Cost or Lifeline Support –
Functionality in Emergency Situations (600)
Filing Regulations: 47 C.F.R. § 54.313(a)(6); 47 C.F.R. § 54.422(b)(4)
Purpose: ETCs must certify compliance regarding the ability to function in emergency
situations.
Line 600 – Functionality in Emergency Situations Certification: Provide a response (yes or no)
to certify you are able to function in emergency situations, as required in 47 C.F.R. §
54.313(a)(6) {for High-cost Recipients} and 47 C.F.R. § 54.422(b)(4){for Low-income Only
Recipients } and set forth in 47 C.F.R. § 54.202(a)(2).
Line 610 – Description of Functionality in Emergency Situations: Attach a detailed description
of how you are able to function in emergency situations, as required in 47 C.F.R. § 54.313(a)(6)
{for High-cost Recipients} and 47 C.F.R. § 54.422(b)(4){for Low-income Only Recipients } and
set forth in 47 C.F.R. § 54.202(a)(2).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting by All Recipients of High-Cost Support – Company Voice Price
Offerings (700)
Filing Regulations: 47 C.F.R. § 54.313(a)(7)
Purpose: ETCs must report their voice telephony service price offerings. ETCs must report local
service rates and state fees in effect as of January 1st of the reporting year.
Line 701 – Residential Local Service Charge Effective Date: Provide the effective date, January
1st of the reporting year, of the local service rates which has been approved by the state or
territorial regulatory agency with jurisdiction.
Line 702 – Single State-wide Residential Local Service Charge: Enter the rate on this line if
your company has a single state-wide local service charge which has been approved by the state
or territorial regulatory agency with jurisdiction. Leave blank if not applicable. {note: only
populate a single line of data in the line 703 worksheet in the event a single state-wide
residential local service charge is offered.}
{Note: For incumbent carriers: If you do not have a single, state-wide local service charge, you
must separately report the rate for each exchange. Each line with the worksheet (at line 703)
should cover a single exchange’s rate. For CETCs: Each line with the worksheet should cover a
residential rate level which applies to the entire study area; if the lines of data extend beyond the
bottom of the worksheet, it will be found on a separate attachment.}
Line 703 – Column a1 – State: The state where your study area is located.
Line 703 – Column a2 – Exchange (ILEC): For ILECs, provide the exchange name associated
with this line of data within the worksheet.
Line 703 – Column a3 – SAC (CETC): For CETCs, provide the study area code (SAC)
associated with this line of data within the worksheet.
Line 703 – Column b1 – Rate Type: Provide the type residential local service (flat rate /
measured / metered) which the ETC provides to the customers identified as per the January 1st
access line count of the Program Year.
Line 703 – Column b2 - Residential Rate: For the wire center or census block cited in column
“a2”, report each of your company’s voice telephony service price offerings. In addition, report
your company’s rates in effect as of January 1 of the reporting year for residential local service
for all portions of your service area, as well as state fees, as specified below. State regulated fees
are limited to state subscriber line charges, state universal service fees and mandatory extended
area service charges. Other state fees, such as state 911 fees, may not be included. Federal
subscriber line charges are not included.
For local service provided pursuant to measured or message rate plans – in which customers do
not receive unlimited local calling, but instead pay a per-minute or per-call charge for some or all
calls – the local service rate reported by ETCs should reflect the basic rate for local service plus
the additional charges incurred for measured service, using the mean number of minutes or

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

message units for all customers subscribing to that rate plan multiplied by the applicable rate per
minute or message unit.
For customers subscribing to bundled service, ETCs should report the local service rate as
tariffed, if applicable, or as itemized on end-user bills. If an ETC neither tariffs nor itemizes the
local voice service rate on bills for bundled services, it may report the rate of a similar standalone local voice service that it offers to consumers in that study area.
Line 703 – Column b3 – State Subscriber Line Charge: For the wire center / census block cited
in column “a2”, provide the approved state commission subscriber line charge. 32 The amounts
should be reported on a per-line basis.
Line 703 – Column b4 – State Universal Service Fee: For the wire center / census block cited in
column “a2”, provide the approved state commission universal service fee. 33 The amounts
should be reported on a per-line basis.
Line 703 – Column b5 – Mandatory Extended Area Service Charge: For the wire center / census
block cited in column “a2”, provide any approved state commission “mandatory” extended area
service charges. 34 The amounts should be reported on a per-line basis.
Line 703 – Column c – Total Per-Line Fees: The calculated total of the per-line amounts in
columns “b2” through “b5”.

32

47 C.F.R. § 54.318(e); Connect America Fund et al., WC Docket Nos. 10-90, et al., Report and Order and Further
Notice of Proposed Rulemaking, 26 FCC Rcd 17663, 17751 para. 238 (2011).

33
34

Id.
Id.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting by Recipients of High-Cost Support – Company Broadband Price
Offerings (710)
Filing Regulations: 47 C.F.R. § 54.313(a)(7)
Purpose: Incumbent ETCs must report the broadband service price offerings for the provision of
retail broadband Internet access to end-user customers. Report each broadband service offering
that meets or exceeds the high-cost speeds and usage allowance (if any) requirements and the
corresponding rate, as of January 1st of the reporting year. CETCs are not required to provide
this information.
{Note: Separately report each broadband service offering that meets or exceeds the high-cost
speeds and usage allowance (if any) requirements. A service offering is a service at a particular
speed and usage allowance, if any. If uniform broadband rates are not offered throughout your
service area, you must separately report each rate for each service for each exchange. Each line
with the worksheet should cover a residential rate level which applies to that exchange; if the
lines of data extend beyond the bottom of the worksheet, it will be found on a separate
attachment. If uniform broadband rates are offered throughout your service area, only populate
a single line of data for each of those service offerings and enter “ALL” in column a2.}
Line 711 – Column a1 – State: The state where your study area is located.
Line 711 – Column a2 – Exchange (ILEC): Provide the exchange name associated with this line
of data within the worksheet. Enter “ALL” in this field if the broadband service offering you are
entering on this line of data is offered throughout your service area.
Line 711 – Column b1 - Residential Rate: Report the total rate offered to residential end-user
customers for each broadband service at a given speed (and usage allowance, if any) that meets
or exceeds the high-cost broadband service requirements.
Line 711 – Column b2 – State Regulated Fees: Report the sum of any relevant state regulated
fees, if any, charged to the customer as a separate line item.
Line 711 – Column c – Total Rates and Fees: The calculated sum of columns “b1” and “b2” per
line amounts.
Line 711 – Column d1 – Broadband Service Download Speed: Report the broadband service
download speed at this reported rate (report in Megabits per second, or Mbps).
Line 711 – Column d2 – Broadband Service Upload Speeds: Report the broadband service
upload speed at this reported rate (report in Megabits per second, or Mbps).
Line 711 – Column d3 – Usage allowance(s): Report usage allowance(s), if any, for the
broadband service offered at this reported rate (Gigabits).
Line 711 – Column d4 – Usage allowance(s) Action Taken When Limit Reached: Select the
action taken once usage allowance is reached; Identify your response from the choice of
“Overage Charge,” “Blocking Traffic,” “Rate-limiting,”or “Other (please include brief
explanation).”

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting By All Recipients of Either High-Cost or Lifeline Support – Operating
Companies and Affiliates (800)
Filing Regulations: 47 C.F.R. § 54.313(a)(8); 47 C.F.R. § 54.422(a)(1)
Purpose: ETCs must report their holding company, operating companies, affiliates, as defined
under section 3 of the Communications Act, and any branding (a “dba,” or “doing-business-as
company” or brand designation), as well as universal service identifiers for each Study Area
Code as that term is used by the Administrator as required in 47 C.F.R. § 54.313(a)(8){for Highcost Recipients} and 47 C.F.R. § 54.422(a)(1){for Low-income Only Recipient Companies}.
For purposes of this requirement, you are required to report all affiliates that are designated as
ETCs or that provide retail broadband Internet access to end-user customers.
Line 810 – Reporting Carrier: The regulatory identifying name associated with the study area
reported in this document.
Line 811 – Holding Company: The name of the corporate holding company associated with the
study area reported in this document. Please note that this field has been pre-populated and was
derived from holding company and common control name information in the FCC Forms 477
and 499. Carriers will be required to validate Line 811 by completing one of the following three
options:
•
•
•

811A – The Holding Company/Affiliate name in Line 811 is correct.
811B – The Holding Company/Affiliate name in Line 811 is not correct. Selecting this
option will require filers to enter the correct Holding Company/Affiliate name in Line
811C.
811D – The SAC does not have a Holding Company/Affiliate name.

Line 812 – Operating Company: The name of the corporate operating company designation
associated with the study area reported in this document.
{Note: if the lines of data extend beyond the bottom of the worksheet, it will be found on a
separate attachment}
Line 813 – Column a1 – Affiliates: The name of any corporate affiliates associated with the
study area reported in this document. The term “affiliates” has the meaning set forth in section
3(2) of the Act. For purposes of this requirement, you are required to report all affiliates that are
designated as ETCs, and their SACs, or that provide retail broadband Internet access to end-user
customers.
Line 813 – Column a2 – Affiliates’ Study Area Code (SAC): Provide the SAC associated with
the affiliate ETCs.
Line 813 – Column a3 – Brand Designation: For the affiliate ETC listed in column a1, provide
the alternative corporate branding or legal “Doing Business As” designations associated with the

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

study area reported in this document. “Doing Business As” includes brand identifiers for any
product offered in that Study Area Code.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting By Recipients of High-Cost Support – Tribal Lands (900)
Filing Regulations: 47 C.F.R. § 54.313(a)(9)
Purpose: To the extent that the ETC serves Tribal lands, documents or information
demonstrating that it has engaged with Tribal governments, as appropriate.
Line 900 – Tribal Land Offerings: Provide a response (yes or no) to indicate whether the
reporting entity offers services on Tribal lands.
If your response to Line 900 is “yes” then complete Lines 910 - 929.
Line 910 – Tribal Land(s): Identify the Tribal Land(s) on which your company provides service.
Line 920 – Tribal Engagement: Please attach a document that your company has had discussions
with Tribal governments that, at a minimum, included: 35 (i) A needs assessment and deployment
planning with a focus on Tribal community anchor institutions; (ii) Feasibility and sustainability
planning; (iii) Marketing services in a culturally sensitive manner; (iv) Rights of way processes,
land use permitting, facilities siting, environmental and cultural preservation review processes;
and (v) Compliance with Tribal business and licensing requirements. Tribal business and
licensing requirements include business practice licenses that Tribal and non-Tribal business
entities, whether located on or off Tribal lands, must obtain upon application to the relevant
Tribal government office or division to conduct any business or trade, or deliver any goods or
services to the Tribes, Tribal members, or Tribal lands. These include certificates of public
convenience and necessity, Tribal business licenses, master licenses, and other related forms of
Tribal government licensure.
Line 921 – Needs Assessment and Deployment Planning: Please respond (either yes, no, or n/a)
in this box to explain as to whether the attached document, on line 920, contains an explanation
of your company’s actions to address needs assessment and deployment planning with a focus on
Tribal community anchor institutions for the Tribal land network.
Line 922 – Feasibility and Sustainability Planning: Please respond (either yes, no, or n/a) in this
box to explain as to whether the attached document, on line 920, contains an explanation of your
company’s actions to address feasibility and sustainability planning for the Tribal land network.
Line 923 – Marketing Services in a Culturally Sensitive Manner: Please respond (either yes, no,
or n/a) in this box to explain as to whether the attached document, on line 920, contains an
explanation of your company’s actions to address the marketing of services in a culturally
sensitive manner in the Tribal land.

35

47 C.F.R. § 54.313(a)(9); see also Office of Native Affairs and Policy, Wireless Telecommunications Bureau, and
Wireline Telecommunications Bureau Issue Further Guidance on Tribal Government Engagement Obligation
Provisions of the Connect America Fund, WC Docket Nos. 10-90 et al., 27 FCC Rcd 8176 (2012).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Line 924 – Compliance with Right of Way Processes: Please respond (either yes, no, or n/a) in
this box to explain as to whether the attached document, on line 920, contains an explanation of
your company’s actions to comply with the right-of-way processes for the Tribal lands.
Line 925 – Compliance with Land Use Permitting Requirements: Please respond (either yes, no,
or n/a) in this box to explain as to whether the attached document, on line 920, contains an
explanation of your company’s actions to comply with the land use permitting requirements for
the Tribal lands.
Line 926 – Compliance with Facility Siting Rules: Please respond (either yes, no, or n/a) in this
box to explain as to whether the attached document, on line 920, contains an explanation of your
company’s actions to comply with the facilities siting rules for the Tribal lands.
Line 927 – Compliance with Environmental Review Processes: Please respond (either yes, no, or
n/a) in this box to explain as to whether the attached document, on line 920, contains an
explanation of your company’s actions to comply with the environmental review processes for
the Tribal lands.
Line 928 – Compliance with Cultural Preservation Review Processes: Please respond (either yes,
no, or n/a) in this box to explain as to whether the attached document, on line 920, contains an
explanation of your company’s actions to comply with the cultural preservation review processes
for the Tribal lands.
Line 929 – Compliance with Tribal Business and Licensing Requirements: Please respond (either
yes, no, or n/a) in this box to explain as to whether the attached document, on line 920, contains
an explanation of your company’s actions to comply with the Tribal business and licensing
requirements for the Tribal lands.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting By Recipients of High-Cost Support – Rate Comparability (1000)
Filing Regulations: 47 C.F.R. § 54.313(a)(10); 47 C.F.R. § 54.313(a)(12)
Purpose: To certify that voice and broadband rates are reasonably comparable.
Line 1000 – Voice Services Rate Comparability Certification: Please provide a response (either
yes, no, or not applicable) to certify that your pricing of fixed voice services is no more than two
standard deviations above the applicable national average urban rate for voice service, as
published annually by the Wireline Competition Bureau, as required in 47 C.F.R. §
54.313(a)(10).
Line 1010 – Description of Voice Services Rate Comparability: Provide a detailed description of
how your pricing of fixed voice services is no more than two standard deviations above the
applicable national average urban rate for voice service, as published annually by the Wireline
Competition Bureau, as required in 47 C.F.R. § 54.313(a)(10).
Line 1020 – Broadband Services Rate Comparability Certification: Please provide a response
(either yes, no, or not applicable) to certify that the pricing of a service that meets the
Commission’s broadband public interest obligations is no more than the applicable benchmark to
be announced annually in a public notice issued by the Wireline Competition Bureau or is no
more than the non-promotional price charged for a comparable fixed wireline service in urban
areas in the states or U.S. Territories where the eligible telecommunications carrier receives
support, as required in 47 C.F.R. § 54.313(a)(12).
Please note that a response of “yes” requires you to specify which of the two criteria are being
applied as part of your broadband services rate comparability certification.
Line 1030 – Description of Broadband Services Rate Comparability: Provide a detailed
description of how your pricing of broadband services satisfies broadband service rate
comparability requirements, as required in 47 C.F.R. § 54.313(a)(12).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting By Recipients of High-Cost Support – Terrestrial Backhaul Reporting
(1100)
Filing Regulations: 47 C.F.R. § 54.313(g)
Purpose: ETCs must note whether they have access to terrestrial backhaul and, if not, they must
validate their ability to offer broadband service of at least 1 Mbps/256 kbps within the supported
area served by satellite middle-mile facilities.
Line 1100 – Terrestrial Backhaul Certification: Confirm (yes / no) whether terrestrial backhaul
options exist (yes) or whether you’re compelled to rely exclusively on satellite backhaul in your
study area (no). This certification is required per 47 C.F.R. § 54.313(g).
If your response to Line 1100 is “no” then complete Line 1130.
Line 1130 – Confirm Broadband Service Offering: Respond (either yes, no, or not applicable) to
denote whether your company offers broadband service of at least 1 Mbps downstream and 256
kbps upstream within the supported area pursuant to § 54.313(g).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting for All Recipients of Lifeline Support – Lifeline Plans Terms and
Conditions (1200)
Filing Regulations: 47 C.F.R. § 54.422(a)(2)
Purpose: ETCs must provide information describing the terms and conditions of any
voice telephony service plans offered to Lifeline subscribers.
{Note: Options for provisioning the Terms and Conditions of Voice Telephony Lifeline: ETCs
have the option to provide this summary information of their lifeline plan by either attaching a
document at line 1210 or entering a website address at line 1220. Whichever option is selected,
the response must detail the terms and conditions of any voice telephony service plans offered to
Lifeline subscribers, including details on the number of minutes provided as part of all Lifeline
plans offered, additional charges, if any, for toll calls, and rates for each such plan.}
Line 1210 – Terms and Conditions of Voice Telephony Lifeline: If you elect to provide your
Lifeline plan data in document form, please attach a document which details the terms and
conditions of any voice telephony service plans, generally available to the public, offered to
Lifeline subscribers.
Line 1220 – Link to Website: If you elect to provide your Lifeline plan data through a website
link, please provide the public website which details the terms and conditions of any
voice telephony service plans, which has been made generally available to the public, offered to
Lifeline subscribers.
Line 1221 – Information Describing Terms and Conditions: Please check this box to confirm that
the attached document, on line 1210, or the website address, on line 1220, contains an
explanation of the terms and conditions of any voice telephony service plans offered to Lifeline
subscribers.
Line 1222 – Number of Minutes Provided: Please check this box to confirm that the attached
document, on line 1210, or the website address, on line 1220, contains an explanation of the
number of minutes provided as part of all plans offered to Lifeline subscribers.
Line 1223 – Additional Charges: Please check this box to confirm that the attached document, on
line 1210, or the website address, on line 1220, contains an explanation of the additional charges,
if any, for toll calls, and rates as part of all plans offered to Lifeline subscribers.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting by Price Cap Carriers Additional Documentation (2005)
Filing Regulations: 47 C.F.R. § 54.313(b),(c),(d),(e)
Purpose: Consolidates your ETC’s information and certifications as a recipient of incremental
Connect America Fund Phase I support, frozen high-cost support, Connect America ICC support,
and Connect America Fund Phase II support.
Line 2011 – Incremental Connect America Fund Phase I Reporting (3rd Year Certification):
Please provide a response (either yes, no, or not applicable) to this certification request. Any
ETC which receives incremental Connect America Fund Phase I support pursuant to 47 C.F.R. §
54.312(b) and (c) must respond affirmatively to certify it has deployed broadband service to all
the required locations. This certification must be filed in the ETC’s annual report three years
after it accepts funding (pursuant to 47 C.F.R. § 54.312(b) and (c)) as required by 47 C.F.R. §
54.313(b)(1). Further, ETCs must certify they have deployed broadband service in compliance
with the functionality requirements in 47 C.F.R. § 54.313(b)(1)(ii). Please note that, for the July
2017 filing, only Round 2 participants are required to provide this certification.
Line 2015 – Price Cap Carrier Frozen Support Certification (2016 Use of Frozen Support
Certification and future periods): Please provide a response (either yes, no, or not applicable) to
this certification request. Any ETC receiving frozen high-cost support pursuant to 47 C.F.R. §
54.312(a) must respond affirmatively to certify all of the support received in 2015 and
subsequent years was used to build and operate broadband-capable networks to offer broadband
in areas substantially unserved by an unsubsidized competitor. For purposes of complying with
this requirement, the ETC must certify that at least 50% of the locations served are in census
blocks shown as unserved on the National Broadband Map. This certification must be filed by
July 1, 2016 (and future periods) as required by 47 C.F.R. § 54.313(c)(4).
Line 2016 – Price Cap Carrier Connect America Fund ICC Support Certification (Certification
Support Used to Build Broadband): Please provide a response (either yes, no, or not applicable)
to this certification request. Any ETC receiving high-cost support to offset access charges
pursuant to 47 C.F.R. § 54.304 must respond affirmatively to certify that all of the support
received was used to build and operate broadband-capable networks to offer broadband in areas
substantially unserved by an unsubsidized competitor. For purposes of complying with this
requirement, the ETC must certify that at least 50% of the locations served are in census blocks
shown as unserved on the National Broadband Map. This certification must be filed by July 1,
2013 (and future periods) as required by 47 C.F.R. § 54.313(d).
Line 2017A – Connect America Phase II Reporting: Please provide a response (either yes or no)
to indicate whether the ETC is a recipient of Connect America Phase II support.
If your response to Line 2017A is “yes” then complete Line 2017C and Line 2018.
Line 2017C– Connect America Phase II – Capital Expenditures: For the filing due July 1, 2017,
and every year thereafter ending July 1, 2021, recipients of Connect America Phase II support
must submit the total amount of Phase II support, if any, the price cap carrier used for capital
expenditures in the previous calendar year. This is required by 47 C.F.R. § 54.313(e)(1)(ii)(B).
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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Line 2018 – Connect America Phase II - Community Anchor Institutions: For the filing due July
1, 2017, and every year thereafter ending July 1, 2021, recipients of Connect America Phase II
support must attach a list containing the number, names, and addresses of community anchor
institutions to which the eligible telecommunications carrier newly began providing access to
broadband service in the preceding calendar year. This filing is required by 47 C.F.R. §
54.313(e)(1)(ii)(A).
Line 2019 – Connect America Phase II - FCC Form 470 Postings: For the filing due July 1
following full implementation of this requirement, and every year thereafter ending July 1, 2021,
please provide a response (either yes, no, or not applicable) to this certification request. Any
ETC receiving Connect America Phase II support must respond affirmatively that it bid on
category one telecommunications and Internet access services in response to all FCC Form 470
postings seeking broadband service that meets the connectivity targets for the schools and
libraries universal service support program for eligible schools and libraries (as described in §
54.501) located within any area in a census block where the carrier is receiving Phase II modelbased support, and that such bids were at rates reasonable comparable to rates charged to eligible
schools and libraries in urban areas for comparable offerings. This filing is required by 47
C.F.R. § 54.313(e)(1)(ii)(C). This certification will not be required until the July 1 following the
E-Rate program year that this obligation has been fully implemented. Modernizing the E-Rate
Program for Schools and Libraries et al., WC Docket. Nos. 13-184, 10-90, 29 FCC Rcd 15538,
15566-67, para. 72 (2014).
Line 2022 – Incremental Connect America Fund Phase I Reporting: Please provide a response
(either yes, no, or not applicable) to this certification request. Any ETC which receives
incremental Connect America Fund Phase I Round 2 support, in years one, two, and three after
filing a notice of acceptance of funding pursuant to § 54.312(c), must respond affirmatively to
certify that, to the best of the recipient’s knowledge, the locations in question are not receiving
support under the Broadband Initiatives Program or the Broadband Technology Opportunities
Program for projects that will provide broadband with speeds of at least 4 Mbps/1 Mbps. This
filing is required by 47 C.F.R. § 54.313(b)(2)(i). Please note that, for the July 2017 filing, Round
2 participants will provide this certification with respect to year three.
Line 2023 – Incremental Connect America Fund Phase I Reporting: Any ETC which receives
incremental Connect America Fund Phase I Round 2 support, in years one, two, and three after
filing a notice of acceptance of funding pursuant to § 54.312(c), must respond affirmatively that
the attachment on Line 2024 includes a statement of the total amount of capital funding
expended in the previous year in meeting Connect America Phase I deployment obligations,
accompanied by a list of census blocks indicating where funding was spent. This filing is
required by 47 C.F.R. § 54.313(b)(2)(ii). Please provide a response (either yes, no, or not
applicable) that the attachment on Line 2024 includes these elements. Please note that, for the
July 2017 filing, Round 2 participants will provide this information with respect to year three.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Line 2024A – Incremental Connect America Fund Phase I Reporting (funding by census block
attachment): Please provide a response (either yes or no) to indicate whether the ETC is a
recipient of Round 2 Incremental support.
If your response to Line 2024A is “yes” then complete Line 2024B.
Line 2024B – Incremental Connect America Fund Phase I Reporting (funding by census block
attachment): Any ETC receiving Incremental Connect American Fund Phase I Round 2 support
must file an attachment containing a statement of the total amount of capital funding expended in
the previous year in meeting Connect America Phase I deployment obligations, accompanied by
a list of census blocks indicating where funding was spent. This attachment must be provided in
years one, two, and three after filing a notice of acceptance of funding pursuant to § 54.312(c) as
required by 47 C.F.R. § 54.313(b)(2)(ii). Please note that, for the July 2017 filing, Round 2
participants will provide this information with respect to year three.
Line 2025A – Incremental Connect America Fund Phase I Reporting (Geocoded Locations):
Please provide a response (either yes or no) to indicate whether the ETC is a recipient of Round
2 Incremental support.
If your response to Line 2025A is “yes” then complete Line 2025B.
Line 2025B – Geocoded Information for Connect America Fund Phase I (Two- and Three-Year
Milestone Reports): Any ETCs receiving Phase I support must, for each location it intends to
count toward its deployment requirement, file a report containing geocoded latitude and
longitude location information along with census block and wire center information. For each
location to be counted toward satisfaction of the carrier’s deployment obligation, the recipient
must report the following information in its two- and three-year milestone reports: (a) the
location’s census block information as based on the Federal Information Processing Standard
(FIPS) code, (b) the carrier’s NECA-assigned operating company code (OCN), (c) the carrier’s
study area code (SAC), (d) the wire center’s eight digit Common Language Location Identifier
(CLLI) code, (e) the latitude, (f) the longitude. The specified latitude and longitude should be to
six decimal places. If two locations have identical latitude and longitude coordinates, an
explanation should be provided as part of the milestone report. Connect America Fund, WC
Docket 10-90, Report and Order, FCC 13-73 (May 22, 013). Please note that, for the July 2017
filing, Round 2 participants will report locations with respect to year three.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting by Rate-of-Return Carriers Additional Documentation (3005)
Filing Regulations: 47 C.F.R. § 54.313(f)
Purpose: Consolidates the ETC’s information and certifications as a recipient of high-cost
support and high-cost support to offset access charge reductions.
Line 3009 – FCC Form 470 Postings: Please provide a response (either yes, no, or not
applicable) to this certification request. Rate-of-return carrier recipients of high-cost support
must respond affirmatively that it bid on category one telecommunications and Internet access
services in response to all reasonable requests in posted FCC Form 470s seeking broadband
service that meets the connectivity targets for the schools and libraries universal service support
program for eligible schools and libraries (as described in § 54.501) within its service area, and
that such bids were at rates reasonably comparable to rates charged to eligible schools and
libraries in urban areas for comparable offerings. This filing is required by 47 C.F.R. §
54.313(f)(1)(iii). This certification will not be required until the July 1 following the E-Rate
program year that this obligation has been fully implemented. Modernizing the E-Rate Program
for Schools and Libraries et al., WC Docket. Nos. 13-184, 10-90, 29 FCC Rcd 15538, 15566-67,
para. 72 (2014).
Line 3010A – Certification of Public Interest Obligations: Any rate-of-return ETC receiving
support must certify it has taken reasonable steps to provide upon reasonable request broadband
service at actual speeds of at least 10 Mbps downstream/1 Mbps upstream, with latency suitable
for real-time applications, including Voice over Internet Protocol, and usage capacity that is
reasonably comparable to comparable offerings in urban areas, and that requests for such service
were met within a reasonable amount of time. This certification must be filed by July 1, 2015
(and future periods) as required by 47 C.F.R. § 54.313(f)(1)(i).
On this line, please respond (yes - attach certification, no – attach explanation, or not applicable
– no attachment required) to indicate whether this certification may be provided.
If your response to Line 3010A is “yes – attach certification” or “no – attach explanation”
then complete Line 3010B.
Line 3010B – Certification of Public Interest Obligations Attachment: Please attach a document
either providing the certification stated (if yes) or an explanation of non-compliance (if no). This
certification must be filed by July 1, 2015 (and future periods) as required by 47 C.F.R. §
54.313(f)(1)(i).
Line 3012A – Community Anchor Institutions: Any rate-of-return ETC receiving support must
provide a list of the number, names, and addresses of community anchor institutions to which the
ETC newly deployed broadband service in the preceding calendar year. This must be filed
annually by July 1st as required by 47 C.F.R. § 54.313(f)(1)(ii).
On this line, please respond (yes - attach new community anchors, no – no new community
anchors, or not applicable – no attachment required) to indicate whether this list may be
provided.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

If your response to Line 3012A is “yes – attach new community anchors” then complete
Line 3012B.
Line 3012B – Community Anchor Institutions: Please attach a document which contains the
community anchor institution details as required by 47 C.F.R. § 54.313(f)(1)(ii).
Annual Report of Privately Held Rate-of-Return Carriers: Any privately held rate-of-return ETC
must file a full and complete annual report of the company’s financial condition and operations
as of the end of the preceding fiscal year. This annual report must be filed by July 1, 2013, and
each year thereafter and contain all required reporting as required in 47 C.F.R. § 54.313(f)(2).
Line 3013 – Qualify as a Privately Held Rate-of-Return Carriers: Respond (either yes or no)
whether your company, as defined in section 54.313(f)(2), qualifies as a privately held rate-ofreturn carrier who will be required to file financial reports beginning in July 1, 2013, and
annually thereafter.
Line 3014 – Privately Held Rate-of-Return Carrier Who Files Annual RUS Reports: If your
company responded in the affirmative on line 3013, then respond (either yes or no) whether your
company is a privately held rate-of-return carrier receiving loans from the Rural Utilities Service
(RUS) and annually files electronic copies of their annual RUS reports (Operating Report for
Telecommunications Borrowers).
Line 3015: Please check this box to confirm that the attached document, on line 3017, contains
an electronic copy of your annual RUS reports (Operating Report for Telecommunications
Borrowers).
Line 3016: Please check this box to confirm that the attached document, on line 3017, contains a
Balance Sheet, Income Statement and Statement of Cash Flows.
Line 3017 – Privately Held Rate-of-Return Carrier’s Annual RUS Reports: If your company
responded in the affirmative on line 3014, then attach an electronic copy of your annual RUS
reports (Operating Report for Telecommunications Borrowers).
Line 3018 – Privately Held Rate-of-Return Carrier Who Files Annual RUS Reports: If your
company responded in the negative on line 3014 and your company is a privately held rate-ofreturn carrier that is not receiving loans from the RUS, then respond (either yes or no) whether
your company’s financial statements are audited.
If your company’s financial statements are audited in the ordinary course of business your
company must attach either:
(1) a copy of your audited financial statement; or
(2) a financial report in a format comparable to RUS Operating Report for
Telecommunications Borrowers, accompanied by a copy of a management letter and
audit opinion issued by the independent certified public accountant that performed the
company’s financial audit.
If your company’s financial statements are not audited in the ordinary course of business, you
company must attach either:

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

(1) a copy of your financial statement which has been subject to review by an
independent certified public accountant; or
(2) a financial report in a format comparable to RUS Operating Report for
Telecommunications Borrowers, with the underlying information subjected to a review by
an independent certified public accountant and accompanied by an officer certification
that: (a) the carrier was not audited in the ordinary course of business for the preceding
fiscal year; and (b) that the reported data are accurate.
If your company’s response is in the affirmative on line 3018:
Line 3019 – Please check this box to confirm your submission, on line 3026 pursuant to §
54.313(f)(2), contains a copy of their audited financial statement; or a financial report in a format
comparable to RUS Operating Report for Telecommunications Borrowers{see attached
worksheets}.
Line 3020 – Please check this box to confirm your submission, on line 3026 pursuant to §
54.313(f)(2), contains a Balance Sheet, Income Statement and Statement of Cash Flows.
Line 3021 – Please check this box to confirm your submission, on line 3026 pursuant to §
54.313(f)(2), contains a copy of a management letter and/or audit opinion issued by the
independent certified public accountant that performed the company’s financial audit.
If your company’s response is in the negative on line 3018:
Line 3022 – Please check this box to confirm your submission, on line 3026 pursuant to §
54.313(f)(2), contains a copy of your financial statement which has been subject to review by an
independent certified public accountant; or 2) a financial report in a format comparable to RUS Operating
Report for Telecommunications Borrowers {see attached surrogate financial statements 3005a, 3005b,
3005c to be utilized}.

Line 3023 – Please check this box to confirm your submission, on line 3026 pursuant to §
54.313(f)(2), contains the underlying information subjected to a review by an independent certified
public accountant.

Line 3024 – Please check this box to confirm your submission, on line 3026 pursuant to §
54.313(f)(2), contains the underlying information subjected to an officer certification.
Line 3025 – Please check this box to confirm your submission, on line 3026 pursuant to §
54.313(f)(2), contains a Balance Sheet, Income Statement and Statement of Cash Flows.
Line 3026 – Privately Held ROR Non-RUS Filing: If your company is a privately held rate-ofreturn carrier that is not receiving loans from the RUS, then attach a worksheet which is
compliant with the requirements of § 54.313(f)(2).
Line 3027 – Revenue: Enter the revenue amount included in the RUS report attached on line
3017 or the revenue amount included in the audited/reviewed financial statements attached on
line 3026.
Line 3028 – Operating Expense: Enter the operating expense amount included in the RUS report
attached on line 3017 or the operating expense amount included in the audited/reviewed financial
statements attached on line 3026.
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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Line 3029 – Net Income: Enter the net income amount included in the RUS report attached on
line 3017 or the net income amount included in the audited/reviewed financial statements
attached on line 3026.
Line 3030 – Telephone Plant In Service (TPIS): Enter the TPIS amount included in the RUS
report attached on line 3017 or the TPIS amount included in the audited/reviewed financial
statements attached on line 3026.
Line 3031 – Total Assets: Enter the total assets amount included in the RUS report attached on
line 3017 or the total assets amount included in the audited/reviewed financial statements
attached on line 3026.
Line 3032 – Total Debt: Enter the total debt amount included in the RUS report attached on line
3017 or the total debt amount included in the audited/reviewed financial statements attached on
line 3026.
Line 3033 – Total Equity: Enter the total equity amount included in the RUS report attached on
line 3017 or the total equity amount included in the audited/reviewed financial statements
attached on line 3026.
Line 3034 – Dividends: Enter the dividends amount included in the RUS report attached on line
3017 or the dividends amount included in the audited/reviewed financial statements attached on
line 3026.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Annual Reporting by Rural Broadband Experiment Participants - Additional
Documentation (4005)
Filing Regulations: FCC 14-98 (paragraphs 78-80)
Purpose: Consolidates reporting requirements for recipients of Rural Broadband Experiments
support.
Line 4001 – Public Interest Obligations: Please provide a response (either yes or no) to this
certification request. Any recipient of RBE support must certify that the recipient offered
broadband to the identified locations meeting the requisite public interest obligations consistent
with the category for which they were selected, including broadband speed, latency, usage
capacity, and rates that are reasonably comparable to rates for comparable offerings in urban
areas. This filing is required by FCC 14-98 (paragraphs 26-29 and 78).
Line 4003A – Community Anchor Institutions: Recipients of RBE support must provide a list of
the number, names, and addresses of community anchor institutions to which they newly
deployed broadband service in the preceding calendar year. This must be filed annually by July
1st as required by FCC 14-98 (paragraph 79).
On this line, please respond (yes - attach new community anchors or no – no new anchors) to
indicate whether this list will be provided.
If your response to Line 4003A is “yes – attach new community anchors” then complete
Line 4003B.
Line 4003B – Community Anchor Institutions: Please attach a document which contains the
community anchor institution details as required by FCC 14-98 (paragraph 79).
Line 4004A – Broadband Deployment Locations: Recipients of RBE support must provide a list
of locations to which broadband has been deployed as of the June 1st immediately preceding the
July 1st filing deadline for the FCC Form 481 as required by FCC 14-98 (paragraph 80).
Line 4004B – Broadband Deployment Locations: In addition to the locations provided in
4004A, recipients of RBE support must also provide evidence demonstrating that the recipient is
meeting the relevant public service obligations for the identified locations. Materials must at
least detail the pricing, offered broadband speed and data usage allowances available in the
relevant geographic area.

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Certification – Reporting Carrier
Filing Regulations: 47 C.F.R. § 54.313
Purpose: ETCs filing §54.313 and/or § 54.422 annual reporting, must have a company officer
complete this certification to attest to the validity of all information reported in Form 481. As an
ETC, you may choose to complete this filing directly and submit it to the FCC, USAC, and the
relevant state commissions, relevant authority in a U.S. Territory, or Tribal governments, as
appropriate.
Certification to be completed by a reporting carrier, if the carrier is filing annual reporting on
its own behalf.
•

Name of Reporting Carrier: Provide the reporting carrier identification of the Study Area
contained in this Form 481 filing.

•

Signature of Authorized Officer: Provide the signature of the reporting carrier’s
appropriate officer attesting to this Form 481 filing.

•

Date: Provide the date the reporting carrier’s appropriate officer executed this
certification for this Form 481 filing.

•

Printed name of Authorized Officer: Provide the name of the reporting carrier’s
appropriate officer who executed this certification for this Form 481 filing.

•

Title or position of Authorized Officer: Provide the title of the reporting carrier’s
appropriate officer who executed this certification for this Form 481 filing.

•

Telephone number of Authorized Officer: Provide the telephone number of the reporting
carrier’s appropriate officer who executed this certification for this Form 481 filing.

•

Study Area Code of Reporting Carrier: Provide the SAC identification code of the Study
Area contained in this Form 481 filing.(same as line 010).

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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

Certification – Agent / Carrier
Filing Regulations: 47 C.F.R. § 54.313
Purpose: For ETCs filing § 54.313 and/or § 54.422 annual reporting, who elect to designate an
agent to execute the compliance filing on your behalf and submit it to the FCC, USAC, and the
relevant state commissions, relevant authority in a U.S. Territory, or Tribal governments, as
appropriate. If an agent completes the FCC Form 481, an authorized officer of your company
must advise USAC of the identity of your agent, and certify that the actual data provided to your
authorized agent is accurate to the best of his/her knowledge.
Certification of an officer to authorize an agent to file annual reports on behalf of the reporting
carrier
•

Name of the Authorized Agent: Provide the name of the designated agent who will be
executing the compliance filing on the reporting carrier’s behalf.

•

Name of Reporting Carrier: Provide the reporting carrier identification of the Study Area
contained in this Form 481 filing.

•

Signature of Authorized Officer: Provide the signature of the reporting carrier’s
appropriate officer attesting to this Form 481 filing.

•

Date : Provide the date the reporting carrier’s appropriate officer executed this
certification for this Form 481 filing.

•

Printed name of Authorized Officer: Provide the name of the reporting carrier’s
appropriate officer who executed this certification for this Form 481 filing.

•

Title or position of Authorized Officer: Provide the title of the reporting carrier’s
appropriate officer who executed this certification for this Form 481 filing.

•

Telephone number of Authorized Officer: Provide the telephone number of the reporting
carrier’s appropriate officer who executed this certification for this Form 481 filing.

•

Study Area Code of Reporting Carrier: Provide the SAC identification code of the Study
Area contained in this Form 481 filing.(same as line 010).

Certification of agent authorized to file annual reports on behalf of the reporting carrier
•

Name of Reporting Carrier: Provide the reporting carrier identification of the Study Area
contained in this Form 481 filing.

•

Name of the Authorized Agent Firm: Provide the name of the authorized agent firm who
completed the compliance filing on the reporting carrier’s behalf.
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Instructions for Completing FCC Form 481
OMB Control No. 3060-0986 (High-Cost)
OMB Control No. 3060-0819 (Low-Income)
November 2016

•

Signature of Authorized Agent or Employee of Agent: Provide the signature of
designated agent, or their employee, who completed this Form 481 filing on the reporting
carrier’s behalf.

•

Date : Provide the date the designated agent, or their employee executed this certification
for this Form 481 filing.

•

Name of Authorized Agent Employee: Provide the name of the agent firm’s employee
who executed this certification for this Form 481 filing.

•

Title or position of Authorized Agent or Employee of Agent: Provide the title of the
reporting carrier’s designated agent, or their employee who executed this certification for
this Form 481 filing.

•

Telephone number of Authorized Agent or Employee of Agent: Provide the telephone
number of the reporting carrier’s designated agent, or their employee who executed this
certification for this Form 481 filing.

•

Study Area Code of Reporting Carrier: Provide the SAC identification code of the Study
Area contained in this Form 481 filing.(same as line 010).

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