Telecommunications Relay Services and Speech-to-Speech Services for Individuals with Hearing and Speech Disabilities, CG Docket No. 03-123, Financial Data, Complaints, and Other Compliance Information

DRAFT – NOT FOR PUBLIC USE

Not Approved by OMB

2017 Version

TRS Fund State TRS Administrator Form

OMB Control Number 3060-XXXX

Estimated Average Burden Hours Per Response: 1.0 Hour

Interstate TRS Fund

2017 Annual State Rate Data Request

_{Filing Instructions}

Should you have any questions about these instructions or completion/content of the forms, please contact Bob Loube at 301-681-0338 or bobloube@earthlink.net. Questions about the submission of this data request can be made to Andy Morrow at TRSDataRequest@rolkaloube.com or call 717-585-6605.

Filing Requirements / Schedule / File Preparation

Form required of all states and US territories:

 Rate and Demand

Form to be completed as appropriate:

 Additional Costs Paid to Provider

Filing deadline:

_{Forms must be emailed to TRSDataRequest@rolkaloube.com on or before February 20,} 2018.

Naming your file:

Each Excel workbook must be saved and submitted as a whole collection of completed data forms using this filing naming template: xx_2017_Annual_v.xls, example: PR_2017_Annual_0.xls

xx Represents an abbreviation of the state or US territory (i.e. PA, DC, PR)

v Represents a single digit for the version of the filing. The first filing submitted for the carrier should be 0. If the file is being replaced for some reason, increment by 1 each time a replacement file is created for submission.

General Information

On November 19, 2007, the Federal Communications Commission released a Report and Order (FCC 07-186) adopting new cost recovery methodologies for the various forms of TRS. For traditional TRS, STS, and CTS, the Commission adopted the

MARS Plan. One MARS rate is calculated that applies to Interstate TRS and STS, and one MARS rate is calculated that applies to Interstate CTS (and currently all IP CTS).

Under the MARS plan each January the Fund Administrator will request each state TRS administrator, and each provider of TRS, STS, and CTS to provide the following data for the previous calendar year: (1) per-minute compensation rates for intrastate traditional TRS, STS, and CTS; (2) whether the rate applies to session minutes or conversation minutes; (3) the number of intrastate session minutes for traditional TRS, STS, and CTS; and (4) the number of intrastate conversation minutes for traditional TRS, STS, and CTS. If the contractual per-minute compensation rate does not include all of the costs paid by the state to the provider for the relay service, the state should also list other amounts paid to the provider during the relevant calendar year. All information submitted will be considered by RLSA to be confidential.

The intrastate minutes also include allocated 800-number, 900-number, and inbound two-line CTS minutes allocated as intrastate minutes (FCC DA 08-1476 ¶15). These allocated intrastate minutes must be included in the MARS calculation to ensure the rate reflects all intrastate minutes compensated by the states.

Completing the “Rate and Demand Worksheet”

Per the Commission Report and Order FCC 07-186, each state TRS administrator and each provider of interstate TRS and STS is to provide the following data for the previous calendar year: per-minute compensation rates for intrastate traditional TRS and STS; whether the rate applies to session minutes or conversation minutes; the number of intrastate session minutes for traditional TRS and STS; and the number of intrastate conversation minutes for traditional TRS and STS.

Per the Commission Report and Order FCC 07-186, each state administrator and each provider of CTS is to provide the following data for the previous calendar year:

per-minute compensation rates for intrastate CTS; whether the rate applies to session minutes or conversation minutes; the number of intrastate session minutes for CTS; and the number of intrastate conversation minutes for CTS.

Header Instructions:

1. Jurisdiction: Enter the two character abbreviation for the state or territory being reported (such as “PR”, “VI”, “DC”, etc.).

2. Prepared By: Enter the name of the person responsible for the content of this report.

3. Telephone: Enter the telephone number, including an extension if appropriate, of the person named in step 2.

4. Email Address: Enter the email address of the person named in step 2.

Column Instructions: (Note that the jurisdiction column will complete automatically once a service type and provider have been entered.)

1. Service Type: Select the service type using the drop down list or type

“TRS”, “STS” or “CTS”.

2. Provider: Enter the name of the service provider.

3. Rate Start Date: Enter a valid date including month, day and year when the contract rate became effective (such as “3/1/2017”). Note: Only rates that were in affect at some point during 2017 are to be reported.

4. Rate End Date: Enter a valid date including month, day and year when the contract rate terminates (such as “9/30/2017”). Note: Only rates that were in affect at some point during 2017 are to be reported.

5. Conversation Rate: Enter the per-minute compensation rate when the compensation rate is based upon actual intrastate conversation minutes (such as “4.52”). The currency format is already configured within the form and therefore, a dollar sign should not be typed.

6. Session Rate: Enter the per-minute compensation rate when the compensation rate is based upon actual intrastate session minutes (such as “4.52”). The currency format is already configured within the form and therefore, a dollar sign should not be typed.

7. Conversation Minutes: Enter the total intrastate conversation minutes for the period in which the rate was effective during the calendar year 2017.

8. Session Minutes: Enter the total intrastate session minutes for the period in which the rate was effective during the calendar year 2017.

Additional Cost Paid to the Provider

Please identify any incentives or services that were paid to a TRS provider during calendar year 2017 in addition to the payments reported on the “rate and demand” worksheet.

Column Instructions: (Note that the jurisdiction column will complete automatically once a service type and provider have been entered.)

1. Provider: Enter the name of the service provider.

2. Service Type: Select the service type using the drop down list or type either “TRS”, “STS” or “CTS”.

3. Rate Start Date: Enter a valid date including month, day and year when the rate being reported began (such as “3/1/2017”).

4. Rate End Date: Enter a valid date including month, day and year when the rate being reported terminates (such as “9/30/2017”).

5. Amount: Enter the amount of additional payments to the provider. The currency format is already configured within the form and therefore, a dollar sign should not be typed.

6. Description: Describe the type of cost or incentive paid to the provider.

Questions:

_{Q: My state is somewhat unique among states as we pay a monthly TRS rate}

based on center operating costs, not a per minute compensation rate as requested. How do I best capture that information on the form for you to use?

A: Do not complete the rate portion of the “rate and demand” form because it obviously does not apply to this situation. We are also interested in the amount of TRS demand in the prior year, so please enter the number of minutes, if possible.

In the form, “Add. Cost Paid to Provider”, please complete this form. In the “amount” column, enter the annual amount paid to the provider. However, if the rate was established for a portion of the year, enter the amount paid for that portion. Indicate in the rate start and end date columns, the portion of the year that the rate was in effect. Use a separate row each time the rate changed.

Q: Our rate for STS is included in the monthly TRS rate. Do I list STS on the form separately, or note that the monthly TRS rate includes STS in the "provider" column?

A: In the “description” column, explain how the compensation is determined. If STS and TRS are combined, indicate that. Do not try to make an artificial separation of the payments if there is no basis for the separation. However, if you know the costs for TRS separately from the costs of STS, you can provide that information in the description column.

Persons willfully making false statements on this form can be punished by fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. §1001.

PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS

The FCC is authorized under the Communications Act of 1934, as amended, to collect the information we request in this form. If we believe there may be a violation or a potential violation of a FCC statute, regulation, rule or order, your certification 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 certification may be disclosed to the Department of Justice or a court or adjudicative body when a) the FCC; or b) any employee of the FCC; or c) the United States Government is a party of a proceeding before the body or has an interest in the proceeding.

We have estimated that this collection of information will take 1.0 hour annually. Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, Office of Managing Director, AMD-PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060-XXXX). We will also accept your PRA comments if you send an e-mail to PRA@fcc.gov.

Please DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. 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 OMB control number and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-XXXX.

THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-

579, DECEMBER 31, 1974, 5 U.S.C. SECTION 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

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