FCC Form 471 Emergency Connectivity Fund Program - Description of Ser

OMB Control No. 3060-1286 Estimated Time per Response

[Month] 2022 4.5 hours

Emergency Connectivity Fund Program

Description of Services Requested and Certification ECF FCC Form 471 (using FCC Form 471 information collection requirements approved pursuant to OMB Control No. 3060-0806)

(Note: This is a representative description of the information to be collected via the online portal and is not intended to be a visual representation of what each applicant will see. Where possible, information already pre-filed in the system portal can be carried forward and auto-populated into the form. Also, where the system has the input to automatically generate calculations and other information for the form, it will provide that information).

#	Section	Field Description	Purpose/Instructions
1	Basic Information	Form Nickname	To create a unique identifier for this submission, the applicant simply enters a nickname (e.g., 2016 FY ABC School Form 471).
2	Basic Information	FCC Form 471 Application Number	Auto-generated by the system: This is a USAC-assigned unique identifier for this submission.
3	Basic Information	Applicant Name	This is the name of the organization submitting this form—school, school district, library (outlet/branch or system) or a consortium of those entities (schools, libraries, or schools and libraries). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
4	Basic Information	Funding Year	Auto-generated by the system based on the funding year of the next application window: This is the Funding Year for which service are sought.
5	Basic Information	Entity Number	Auto-generated by the system: This is the Unique identifier assigned by USAC to the organization listed in Applicant Name.
6	Basic Information	FCC Registration Number	This is the unique FCC identifier for the organization listed as the applicant. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
7	Basic Information	UEI Number	This is a unique entity identifier for the organization listed as the applicant. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
8	Basic Information	Mailing Address	This is the mailing address for the applicant. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
9	Basic Information	Telephone Number	This is the main telephone line for the applicant which may/may not be the same as the telephone number for the person who should be contacted with questions about this application. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
10	Basic Information	Type of Applicant	Options are: school, school district, library/library system, consortium, statewide consortium. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
11	Basic Information	Applicant Attributes	Attributes for a School or School District include: Public, Private, Charter and ESA. Attributes for a Library System include: Public and Private. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
12	Basic Information	Contact Person’s Name	Provide the name of the person who should be contacted with questions about this application. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
13	Basic Information	E-mail Address	E-mail Address of the Contact Person. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
14	Basic Information	Contact Person’s Telephone Number	Telephone Number of the Contact Person. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
15	Basic Information	Holiday/vacation/summer contact information	This line will collect name, phone number, and email of the holiday/vacation/summer contact.
16	Basic Information	Website	Website URL for school district, school or library. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
17	Basic Information	Consultant Information	System will ask for consultant name, registration number, consultant’s employer, street address and telephone number, and e-mail address. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
18	Entity Information	Entity Number	Unique identifier assigned by USAC to each school, library outlet/branch, or NIF.
19	Entity Information	Name of the Individual School or Library Outlet/Branch	If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
20	Entity Information	Physical Address	Physical address of each Individual School or Library Outlet/Branch. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
21	Entity Information	National Center for Education Statistics (NCES) School ID or Federal-State Cooperative System (FSCS) Library ID	For each school, this line will collect the NCES School ID. For each library, this line will collect the FSCS Library ID. (This line is not applicable to NIFs.) This information will pre-populated into this submission by USAC, if available.
22	Entity Information	Urban or Rural	The system will automatically determine the Urban/Rural status of the entity based on the physical address associated with that entity.
23	Entity Information	State Local Education Agency (LEA) ID	State school IDs (LEA code and school code). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
24	Entity Information	State School ID	State school IDs (LEA code and school code). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
25	Entity Information	Endowment Amount (Dollars)	Schools will be asked if they have an endowment and the amount of their endowment. This is related to the certification they make that they are eligible because they are a school under the statutory definitions of elementary and secondary schools found in the No Child Left Behind Act of 2001, 20 U.S.C. §§ 7801(18) and (38), that do not operate as for-profit businesses and do not have endowments exceeding $50 million.
26	Entity Information	Maximum number of students on school premises at the same time	This field is defined as the maximum number of students on the premise at the same time. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
27	Entity Information	Maximum student count based on estimate (Yes/No)	Indicate if the maximum number of students in the school is based on an estimate. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
29	Entity Information	School Attributes:	The list of attributes for a School includes: Public, Private, Pre-K, Head Start, Adult Education, Juvenile Justice, Dormitory, Charter, Tribal, New Construction and Educational State Agency (ESA). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
30	Entity Information	Annex	Captures the following fields for an Annex: Name of Annex, Name of Associated School/Library, Entity Number for the Associated School/Library, Physical Address of the Annex, Square Feet (if a Library Annex), and Status (Values are: Active or Closed). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
31	Entity Information	Total Square Footage of library outlet	Used to determine the Category Two budget for libraries. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
32	Entity Information	Main Branch? (Yes/No)	If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
33	Entity Information	School District Billed Entity Number	If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
34	Entity Information	Library Attributes	The list of attributes for a Library includes: Public, Private, Academic, Research, Tribal, Bookmobile, Kiosk, New Construction, Main Branch and State Library Agency. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
35	Entity Information	Institute of Museum and Library Services (IMLS) Locale Code	The IMLS assigns Locale Codes at the entity level (e.g., for each outlet/branch). Note that a library annex will have the same Locale Code as its associated outlet/branch. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
36	Entity Information	Total Number of Students Enrolled in School District	Total number of students in the school district should include all of the students in the school district as a whole, counting each student only once. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
37	Entity Information	Percentage of Students in School District Eligible for NSLP	This is used to determine prioritization in the event that demand exceeds available funding.
38	Entity Information	Category One Discount Rate	System determines the discount rate that will be used to determine prioritization of funding in the event that demand exceeds available funding. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
39	Entity Information	Consortium Discount Calculation	The system will calculate and display the discount percentage rate, based on an average of student count data for all of the member entities participating on the FCC Form 471. This data will be used for prioritization in the event that demand exceeds available funding.
40	Funding Request	Applicant FRN Nickname	Applicants can provide a unique name for each funding request number (FRN) for their own recordkeeping purposes.
41	Funding Request	Funding Request Number (FRN)	USAC’s online system assigns a unique number or FRN to each funding request.
42	Funding Request	Service Type	Applicants will chose from two options: (1) Equipment and (2) Services
43	Funding Request	Service/Delivery Start Date	Provide the date for when services will start, or equipment will be delivered in the funding year for which you are applying.
44	Funding Request	Service/Delivery End Date	Provide the date for when services will end, or equipment will be delivered in the funding year for which you are applying.
45	Funding Request	SPIN	The 9-digit SPIN for the service provider that will provide service(s) on this funding request. If the service provider information is not already in the system, the SPIN will remain blank.
46	Funding Request	Service Provider Name	The online system will populate the full legal name associated with the Service Provider Identification Number entered. Applicant will manually input this information if the service provider information is not already in the system.
47	Funding Request	Service Provider Contact Information	Name, Address, and Phone Number if the applicant is using a service provider who does not have a SPIN number. Applicant will manually input this information if the service provider information is not already in the system.
	If the funding requested above in the “Funding Request” section is for “Services,” applicants fill out the “Funding Request – Line Item for Services” section.
48	Funding Request – Line Item for Services	Narrative	Each Funding Request must include a description of the services being requested. Applicants will also be able to use this field to provide additional information for their request and upload supporting documentation.
49	Funding Request – Line Item for Services	Type of Connection	Applicant will select from a drop-drop menu of types of connections
50	Funding Request – Line Item for Services	Function of Connection	Applicants will select from a drop-down menu of the function of the connection.
51	Funding Request – Line Item for Services	Quantity or # of lines	Only appears for services requests.
52	Funding Request – Line Item for Services	Bandwidth Upload speed	Only appears for services requests.
53	Funding Request – Line Item for Services	Bandwidth Download speed (if different)	Only appears for services requests.
54	Funding Request – Line Item for Services	Basic firewall protection included? (Yes/No)	Only appears for Internet access services.
55	Funding Request – Line Item for Services	Monthly Recurring Unit Cost	Enter the monthly recurring cost for each unit of the service.
56	Funding Request – Line Item for Services	Monthly Quantity	Enter the quantity of monthly recurring services
57	Funding Request – Line Item for Services	Months of Service	Enter the number of months the service is being received.
58	Funding Request – Line Item for Services	Monthly Recurring Cost	Enter the total monthly recurring cost of the service
59		One-time Unit Cost	Enter the one-time or non-recurring costs for the service.
60		One-Time Quantity	Enter the number of units charged one-time
61		Total One Time Costs	Enter the total one-time cost
If the funding requested above in the “Funding Request” section is for “Equipment,” applicants fill out the “Funding Request – Line Item for Equipment” section.
62	Funding Request – Line Item for Equipment	Narrative	Each Funding Request must include a description of the equipment being requested. Applicants will also be able to use this field to provide additional information for their request and upload supporting documentation.
63	Funding Request – Line Item for Equipment	Type of Product (drop down menu)	Applicants will select from a drop-down menu of the equipment that is eligible.
64	Funding Request – Line Item for Equipment	Make	For equipment requests. Only one make per line item.
65	Funding Request – Line Item for Equipment	Model	For equipment requests. Only one model per line item.
66	Funding Request – Line Item for Equipment	One-time Unit Cost	Enter the one-time or non-recurring costs for the equipment
67	Funding Request – Line Item for Equipment	One-Time Quantity	Enter the one-time or non-recurring quantity of the equipment
68	Funding Request – Line Item for Equipment	Total One Time Costs	Enter the total one-time or non-recurring cost of the equipment
69	Funding Request – Line Item for Equipment	One Time Ineligible Cost	Enter the one-time or non-recurring ineligible costs for the equipment.
70	Funding Request – Line Item for Equipment	Extended Line Item Cost	The system will automatically calculate the total amount for this FRN line, based on the information provided.
If the funding requested above in the “Funding Request” section is for “Services,” and the applicant indicated that their requests include a request for Special construction, network equipment or maintenance and operations, applicants fill out the “Funding Request” for “New Construction or Self-provisioned Services” section.
71	Funding Request – Line Item for New Construction or Self-Provisioned	Narrative	Each Funding Request must include a description of the services being requested. Applicant will be asked to provide information on the self-provisioned services that are being requested. Only applicants that can demonstrate that there are not any commercially available services available to provide connectivity to students, school staff, and library patrons and can show the services are cost-effective, will be able to make this selection on the FCC Form 471. Applicants will also be able to use this field to provide additional information for their request and upload supporting documentation.
72	Funding Request – Line Item for New Construction or Self-Provisioned	Function of Connection	Applicable to new construction and self-provisioned service requests. Provides dropdowns of functions that applicant will select from.
73	Funding Request – Line Item for New Construction or Self-Provisioned	Type of Connection	Applicable to new construction and self-provisioned service requests. Provides dropdowns of services that applicants will select from.
74	Funding Request – Line Item for New Construction or Self-Provisioned	Bandwidth Upload speed and unit of measurement	Applicant will provide the upload speed and measurement.
75	Funding Request – Line Item for New Construction or Self-Provisioned	Bandwidth Download speed and unit of measurement	Applicant will provide the download speed.
76	Funding Request – Line Item for New Construction or Self-Provisioned	Basic firewall protection included? (Yes/No)	Only appears for Internet access services.
77	Funding Request – Line Item for New Construction or Self-Provisioned	Number of connections	The applicant is asked to provide the number of connections that will be served.
78	Funding Request – Line Item for New Construction or Self-Provisioned	Monthly Recurring Unit Cost	Enter the monthly recurring cost for the service.
79	Funding Request – Line Item for New Construction or Self-Provisioned	Monthly Quantity	Enter the quantity of units requested
80	Funding Request – Line Item for New Construction or Self-Provisioned	Months of Service	The number of months that the product or service will be supported.
81	Funding Request – Line Item for New Construction or Self-Provisioned	Total Recurring Cost	Enter the total recurring costs requested.
82	Funding Request – Line Item for New Construction or Self-Provisioned	One-time Unit Cost	Enter the one-time or non-recurring costs for the service.
83	Funding Request – Line Item for New Construction or Self-Provisioned	One-Time Quantity	Enter the quantity of non-recurring services requested
84	Funding Request – Line Item for New Construction or Self-Provisioned	Total One Time Costs	Enter the total cost of non-recurring services
85	Funding Request – Line Item for New Construction or Self-Provisioned	Network Equipment	Applicants to identify: type, make, model, qty., costs (monthly and one-time), whether installation costs are included, and eligible versus ineligible costs.
86	Funding Request – Line Item for New Construction or Self-Provisioned	Total Costs	System adds the total recurring and one-time costs requested
	Recipient of Service Information – Requested for Consortium applications only
Questions regarding unmet needs of student, school staff and library patrons
87	Unmet Needs	A set of questions to applicants regarding the unmet needs of their students, school staff, and library patrons.	Applicants will be requested to answer a set of questions regarding the specific unmet needs that existed at the start of the pandemic and how the Emergency Connectivity Funds are being used to address remaining unmet needs.
88	Unmet Needs	Narrative	Applicants will be requested to provide a narrative of they obtained the data to answer these questions and the timing of the data collections or needs assessments. Applicants can upload documentation along with their responses.
Invoicing Mode Selected
89	Invoicing Mode Selected	Invoicing Mode Selected	Applicants will be required to select whether the applicants will be invoicing for the requested equipment and/or service or if the service providers will be invoicing for the requested equipment and services. If the applicant indicated that the service provider will be invoicing, they will also be required to provide documentation from the service provider agreeing to perform the invoicing.
90	Invoicing Mode Selected	FCC Registration Number	This is the unique FCC identifier for the organization listed as the service provide who agreed to invoice on behalf of the applicant. The applicant will be asked to input this number on the application if the service provider’s FCC Registration number cannot be pre-populated.
91	Invoicing Mode Selected	UEI Number	The Unique Entity Identifier (UEI) number is a unique nine-digit identifier for the entity. The applicant will be asked to input the service provider’s UEI number on the application who agreed to invoice on behalf of the applicant if the service provider’s UEI number cannot be pre-populated.
92	Invoicing Mode Selected	Employer Identification Number (EIN)	The EIN is a unique identifier for the businesses. The applicant will be asked to input the service provider’s EIN number on the application who agreed to invoice on behalf of the applicant if the service provider’s EIN number cannot be pre-populated.
Certifications
93	Certifications	Signature of Authorized Person	The form must be certified electronically with the authorized person’s applicant name and password.
94	Certifications	Date Signed	Auto generated by system.
95	Certifications	Name of Authorized Person	This is the name of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
96	Certifications	Title or Position of Authorized Person	This is the title of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
97	Certifications	Physical or mailing address of Authorized Person	This is the address (can be physical address or mailing address) of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
98	Certifications	Telephone Number of Authorized Person	This is the telephone number of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
99	Certifications	Email address of Authorized Person	This is the email address of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
100	Certifications	I am authorized to submit this application on behalf of the above-named applicant and that based on information known to me or provided to me by employees responsible for the data being submitted, I hereby certify that the data set forth in this application has been examined and is true, accurate and complete. I acknowledge that any false statement on this application or on other documents submitted by this applicant can be punished by fine or forfeiture under the Communications Act (47 U.S.C. §§ 502, 503 (b)), or fine or imprisonment under Title 18 of the United States Code (18 U.S.C. § 1001), or can lead to liability under the False Claims Act (31 U.S.C. §§ 3729 – 3733).	The authorized person will be required to make the following certifications to be able to submit the request for funding. The certifications are necessary to ensure the applicant is compliant with the Emergency Connectivity Fund Program rules and to protect the Program from waste, fraud, and abuse.
101	Certifications	In addition to the foregoing, this applicant is in compliance with the rules and orders governing the Emergency Connectivity Fund Program, and I acknowledge that failure to be in compliance and remain in compliance with those rules and orders may result in the denial of funding, cancellation of funding commitments, and/or recoupment of past disbursements. I acknowledge that failure to comply with the rules and orders governing the Emergency Connectivity Fund Program could result in civil or criminal prosecution by law enforcement authorities.	See number 100.
102	Certifications	By signing this application, I certify that the information contained in this application is true, complete, and accurate, and the projected expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, sections 1001, 286-287 and 1341 and Title 31, sections 3729–3730 and 3801–3812).	See number 100.
103	Certifications	The school meets the statutory definition of “elementary school” or “secondary school” as defined in § 54.1700 of this subpart, does not operate as for-profit businesses, and does not have endowments exceeding $50 million.	This certification only shows if schools are the only entities seeking funding on this application. See also number 100.
104	Certifications	The library or library consortia eligible for assistance from a State library administrative agency under the Library Services and Technology Act does not operate as for-profit businesses and whose budgets are completely separate from any school (including, but not limited to, elementary and secondary schools, colleges, and universities).	This certification only shows if libraries are the only entities seeking funding on this application. See also number 100.
105	Certifications	The school, library, or consortia listed on the FCC Form 471 application has complied with all applicable state, local, or Tribal local laws regarding procurement of services for which support is being sought.	See number 100.
106	Certifications	The school or school consortium listed on the FCC Form 471 application is only seeking support for eligible equipment and/or services provided to students and school staff who would otherwise lack connected devices and/or broadband services sufficient to engage in remote learning.	This certification only shows if schools are the only entities seeking funding on this application. See also number 100.
107	Certifications	The library or library consortium listed on the FCC Form 471 application is only seeking support for eligible equipment and/or services provided to library patrons who have signed and returned a statement that the library patron would otherwise lack access to equipment or services sufficient to meet the patron’s educational needs if not for the use of the equipment or service being provided by the library.	Only libraries will see this certification. See number 100.
108	Certifications	The school, library, or consortia is not seeking Emergency Connectivity Fund support or reimbursement for eligible equipment or services that have been purchased and reimbursed in full with other federal pandemic-relief funding, targeted state funding, other external sources of targeted funding or targeted gifts, or eligible for discounts from the schools and libraries universal service support mechanism or other universal service support mechanism.	See number 100.
109	Certifications	The applicant or the relevant student, school staff member, or library patron has received or will receive the equipment and services for which funding is sought.	See number 100.
110	Certifications	The equipment and services the school, library, or consortium purchases using Emergency Connectivity Fund support will be used primarily for educational purposes and will not be sold, resold, or transferred in consideration for money or any other thing of value, except as allowed by § 54.1713.	See number 100.
111	Certifications	The school, library, or consortium has created and will maintain an equipment and service inventory as required by § 54.1715.	See number 100.
112	Certifications	The school, library, or consortium has complied with all program rules and acknowledge that failure to do so may result in denial of discount funding and/or recovery of funding.	See number 100.
113	Certifications	The applicant recognizes that it may be audited pursuant to its application, that it will retain for ten years any and all records related to its application, and that, if audited, it shall produce shall records at the request of any representative (including any auditor) appointed by a state education department, the Administrator, the Commission and its Office of Inspector General, or any local, state, or federal agency with jurisdiction over the entity.	See number 100.
114	Certifications	No kickbacks, as defined in 41 U.S.C. § 8701 and/or 42 U.S.C. § 1320a-7b, were paid or received by the applicant to anyone in connection with the Emergency Connectivity Fund.	See number 100.
115	Certifications	The applicant sought service from existing service providers in the relevant area and that such service providers were unable or unwilling to provide services sufficient to meet the remote learning needs of their students, school staff, or library patrons.	Applicants that are seeking funding for new network construction will be required to provide this additional certification. See also number 100.
Applicants who have not provided an FCC Form 486 or FCC Form 479 certifying compliance with the Children’s Internet Protection Act (CIPA) for the current funding year will need to certify compliance with CIPA on the Emergency Connectivity Fund Program FCC Form 471.
116	CIPA Certifications	I certify that as of the date of the start of Emergency Connectivity Fund program supported services: The recipient(s) of service represented in the Funding Request Number(s) on this Form 471 has (have) complied with the requirements of the Children's Internet Protection Act (CIPA), as codified at 47 U.S.C. § 254(h) and (l). The recipient(s) of service represented in the Funding Request Number(s) on this Form 471 is (are) undertaking such actions, including any necessary procurement procedures, to comply with the requirements of CIPA for the next funding year, but has (have) not completed all requirements of CIPA for this funding year. The Children's Internet Protection Act, as codified at 47 U.S.C. § 254(h) and (l), does not apply because the recipient(s) of service represented in the Funding Request Number(s) on this Form 471 is (are) not receiving support for Internet access, Internet service, or internal connections under the universal service support mechanism for schools and libraries or Internet access or Internet service through the Emergency Connectivity Fund, or connected devices do not use Internet access or Internet service funded through the universal service support mechanism for schools and libraries or the Emergency Connectivity Fund Program.	For applicants who are the administrative authority, the authorized person must certify compliance with the Children’s Internet Safety Act (CIPA) by selecting the certification that is applicable.
117	CIPA Certifications	I certify as the Billed Entity for a consortium that as of the date of the start of Emergency Connectivity Fund program supported services: That the consortium members represented in the Funding Request Number(s) on this Form 471 have complied with the requirements of the Children's Internet Protection Act (CIPA), as codified at 47 U.S.C. § 254(h) and (l). The consortium members represented in the Funding Request Number(s) on this Form 471 are undertaking such actions, including any necessary procurement procedures, to comply with the requirements of CIPA for the next funding year, but has (have) not completed all requirements of CIPA for this funding year. That the Children's Internet Protection Act, as codified at 47 U.S.C. § 254(h) and (l), does not apply because the consortium members represented in the Funding Request Number(s) on this Form 471 are not receiving support for Internet access, Internet service, or internal connections under the universal service support mechanism for schools and libraries or Internet access or Internet service through the Emergency Connectivity Fund, or connected devices do not use Internet access or Internet service funded through the universal service support mechanism for schools and libraries or the Emergency Connectivity Fund Program.	For applicants who are Billed Entity for a consortium, the authorized person must certify compliance with the Children’s Internet Safety Act (CIPA) by selecting the certification that is applicable.

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