Business or other for-profit

Instructions for Completing FCC Form 481

OMB Control No. 3060-0986 (High-Cost)

OMB Control No. 3060-0819 (Low-Income)

[Month] 2022

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 high-cost 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 PRA@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.

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

On July 6, 2017, the Federal Communications Commission (FCC) adopted an order streamlining the certification and reporting requirements associated with high-cost support.³ Beginning with the July 1, 2018 filing, the FCC Form 481 no longer requires that high-cost recipients file information regarding network outages; unfulfilled service requests; the number of complaints received by an ETC per 1,000 subscribers for voice and broadband services; and pricing for voice and broadband services. The FCC Form 481 also no longer includes certifications for high-cost recipients regarding service quality standards and consumer protection rules. Finally, the FCC centralized filing of the FCC Form 481; ETCs no longer file duplicate copies of FCC Form 481 with the FCC and with states, U.S. Territories, and/or Tribal governments.

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 FCC’s rules and progress toward its universal service goals.

II. The Carrier or the Carrier’s Agent May File This Form

As an ETC, your filing requirements will determine how this form is submitted to the various federal, state, and local entities.

Carriers submitting under High-Cost requirements (54.313) and joint High-Cost and Lifeline requirements (54.313/54.422) may complete this filing directly and submit it to the Universal Service Administrative Company (USAC), the universal service Administrator. Alternatively, you can elect to designate an agent to execute the compliance filing on your behalf and submit it to USAC. Instructions for agents are noted below.

Carriers submitting under Lifeline requirements (54.422) only 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. 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. Instructions for agents are noted below.

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;

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. § 1001.⁴

III. When Must ETCs Make These Compliance Filings

1. 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.⁵ 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 54.1009.⁶

• Section 54.313 annual reports are due annually on July 1^st each year.⁷

• ETCs must file with USAC.⁸ 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.

• Section 54.313(a)(1) requires ETCs to make certifications as to their ability to remain functional in emergency situations as set forth in section 54.202(a)(2).⁹ ETCs must separately file these data for voice and broadband service.¹⁰

• Section 54.313(a)(4) requires ETCs, beginning July 1, 2013, and annually thereafter, to report ownership information.¹¹

• Section 54.313(a)(5) 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.¹²

• Section 54.313(a)(2) requires ETCs to certify that the pricing of their voice services are no more than two standard deviations above the applicable national average urban rate for voice service, which will be specified annually in a public notice issued by the FCC’s Wireline Competition Bureau.¹³

• Section 54.313(a)(6) 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.¹⁴ At this time, ETCs are not required to submit any information pursuant to this section.

• Section 54.313(a)(3) 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.¹⁵

• 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.¹⁶

• 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.¹⁷

• Section 54.313(e) requires recipients of Connect America Phase II, Uniendo a Puerto Rico Stage 2, and Connect USVI Fund Stage 2 support to provide certain certifications and other details related to their broadband obligations.¹⁸

• Section 54.313(f) requires rate-of-return ETCs to provide certain certifications and other details related to their broadband obligations.¹⁹

• Section 54.313(f)(2) requires privately held rate-of-return ETCs, beginning in July 1, 2013, and annually thereafter, to file financial reports.²⁰

  • 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).

  • 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.

  • 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.

• Section 54.313(f)(4) requires rate-of-return ETCs receiving high-cost support to provide the name of any cost consultant and cost consulting firm, or other third-party, retained to prepare financial and operations data disclosures submitted to the National Exchange Carrier Association (NECA), USAC, or the Commission.

• 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.²¹ 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 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.

  • ETCs subject to section 54.313(h) should file separately with USAC their rates and line counts on the Rate Floor Data Collection form.

• Section 54.313(l), in addition to the information and certifications in paragraph (a) of this section, requires any competitive eligible telecommunications carrier participating in the Alaska Plan to provide certification as to whether any terrestrial backhaul or other satellite backhaul became commercially available in the previous calendar year in areas that were previously served exclusively by satellite backhaul, if the funding recipient identified in its approved performance plans that it relied exclusively on satellite backhaul for a certain portion of the population in its service area. To the extent that new terrestrial backhaul facilities are constructed or other satellite backhaul become commercially available, the funding recipient must provide a description of the backhaul technology; provide the date on which that backhaul was made commercially available to the carrier; provide the number of the population within their service area that are served by the newly available backhaul option; and to the extent the funding recipient has not already committed to providing 4G LTE at 10/1 Mbps to the population served by the newly available backhaul by the end of the plan term, submit a revised performance commitment factoring in the availability of the new backhaul option no later than the due date of the Form 481 in which they have certified that such backhaul became commercially available.

• Section 54.313(m) requires price cap carriers and fixed competitive ETCs that elect to continue receiving support pursuant to section 54.312(d) or section 54.307(e)(2)(iii), i.e., phase-down support, to certify that all such support the company received in the previous year was used to provide voice service throughout the high-cost and extremely high-cost census blocks where they continue to have the federal high-cost ETC obligation to provide voice service pursuant to section 54.201(d) at rates that are reasonably comparable to comparable offerings in urban areas. These certifications must be provided starting July 1, 2020 and annually thereafter on July 1 for each subsequent year the price cap carrier or fixed competitive ETC receives phase-down support.

• Section 54.313(n) requires that recipients of Uniendo a Puerto Rico Fund Stage 2 fixed or mobile support and recipients of Connect USVI Fund Stage 2 fixed or mobile support certify that such support was not used for costs that are (or will be) reimbursed by other sources of support, including federal or local government aid or insurance reimbursements; and that support was not used for other purposes, such as the retirement of company debt unrelated to eligible expenditures, or other expenses not directly related to network restoration, hardening, and expansion consistent with the framework of the Uniendo a Puerto Rico Fund or Connect USVI Fund, respectively. Section 54.313(n) also requires that recipients of fixed or mobile support from Stage 2 of the Uniendo a Puerto Rico Fund or of the Connect USVI Fund certify that they have conducted an annual review of the documentation required by section 54.1515(a)-(c) to determine the need for and to implement changes or revisions to disaster preparation and response documentation.

• Section 54.313(o) requires that recipients of Uniendo a Puerto Rico Fund or of Connect USVI Fund Stage 2 mobile support certify that they are in compliance with all requirements for receipt of such support to continue receiving Stage 2 mobile disbursements.

2. 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.²²

• Section 54.422 annual reports are due annually on July 1^st 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.²³

• Section 54.422(a)(1) requires all such ETCs to report ownership information.²⁴

• 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.²⁵

• 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}:²⁶

• Information regarding service outages,

• Number of complaints received per 1,000 connections,

• Certification of compliance with applicable minimum service standards

• Certification that the carrier is able to function in emergency situations.

2. Supply Chain Certification for All ETCs

• Section 54.9 prohibits the use of universal service support to purchase, obtain, maintain, improve, modify, or otherwise support any equipment or services produced or provided by any company posing a national security threat to the integrity of communications networks or the communications supply chain.²⁷ In the 2019 Supply Chain Order, the Commission directed the Wireline Competition Bureau, in coordination with USAC, to require all ETCs to certify compliance with section 54.9.²⁸

• Section 54.9 annual certifications are due annually on July 1.

IV. Filing Instructions

As an ETC, your filing requirements will determine how this form is submitted to the various federal, state, and local entities.

Carriers submitting under High-Cost requirements (54.313) and joint High-Cost and Lifeline requirements (54.313/54.422)

• 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/portal/login. A Form 481 is required to be submitted through this link. Instructions on how to file electronically are also found at USAC’s High Cost Forms website at https://www.usac.org/high-cost/resources/forms-and-filing-deadlines/. Applicants without adequate Internet access to submit the forms online should contact USAC’s High Cost Division (HC) (1-844-357-0408 or HCquestions@usac.org) to make alternative arrangements.

• Carriers submitting under the High-Cost requirements or joint High-Cost and Lifeline requirements may seek confidential treatment of portions of their FCC Form 481 pursuant to section 0.459 of the FCC’s rules, using USAC’s Request Confidentiality page online. Such carriers may submit a confidentiality request by following these steps:

• Select checkboxes for each line item for which the carrier is requesting confidentiality by navigating to each section. Please note that all line items that are pre-determined to be non-public by the FCC will be listed with a disabled checkbox.

• Provide an explanation, for each selected line item, that includes a response to all of the eight questions listed.

• Review and edit explanations as they will not be considered as a request for confidentiality unless all eight questions are answered per selected line item. Please note that an explanation is required per line item requested in order for the confidentiality request form to be submitted.

• Provide the appropriate contact information in case of any follow-up questions or concerns by USAC and/or FCC personnel.

• Submit the form to view a confirmation page and to receive a confirmation email regarding the confidentiality request form.

Carriers submitting under Lifeline requirements (54.422) only

• 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/portal/login. A Form 481 is required to be submitted through this link. Instructions on how to file electronically are also found at USAC’s High Cost Forms website at https://www.usac.org/high-cost/resources/forms-and-filing-deadlines/. Applicants without adequate Internet access to submit the forms online should contact USAC’s High Cost Division (HC) (1-844-357-0408 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 Marlene H. Dortch, Secretary, Federal Communications Commission, Office of the Secretary, 9050 Junction Drive, Annapolis Junction, MD 20701. The filing hours are 8:00 a.m. to 4:00 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 Marlene H. Dortch, Secretary, Federal Communications Commission, Office of the Secretary, 9050 Junction Drive, Annapolis Junction, MD 20701.

• U.S. Postal Service first-class, Express, and Priority mail must be addressed to Marlene H. Dortch, Secretary, Federal Communications Commission, Office of the Secretary, 45 L Street, NE, Washington, DC 20554.

• Carriers that are submitting under the Lifeline requirements only and seek confidential treatment of portions of their FCC Form 481 should file with the FCC pursuant to section 0.459 of the FCC’s rules. Such carriers should follow the local rules to file with their relevant state commission, relevant authority in a U.S. Territory, or Tribal governments, as appropriate.

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.

Annual Reporting for Recipients of Lifeline Support – Service Outage Reporting (200)

Filing Regulations: 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)

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.

Annual Reporting for Recipients of Lifeline Support – Complaints per 1,000 Customers (400)

Filing Regulations: 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.

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).

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. § 54.422(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. § 54.422(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. § 54.422(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.

Annual Reporting for Recipients of Lifeline Support – Service Quality Standards and Consumer Protection Rules (500)

Filing Regulations: 47 C.F.R. § 54.422(b)(3)

Purpose: ETCs must certify compliance with applicable service quality standards and consumer protection rules.

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.

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)(1); 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)(1) {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)(1) {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).

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)(4); 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)(4){for High-cost 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: For Line 813, 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 study area reported in this document. “Doing Business As” includes brand identifiers for any product offered in that Study Area Code.

Annual Reporting By Recipients of High-Cost Support – Tribal Lands (900)

Filing Regulations: 47 C.F.R. § 54.313(a)(5)

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:²⁹ (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 not applicable) 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 not applicable) 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 not applicable) 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.

Line 924 – Compliance with Right of Way Processes: Please respond (either yes, no, or not applicable) 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 not applicable) 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 not applicable) 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 not applicable) 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 not applicable) 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 not applicable) 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.

Annual Reporting By Recipients of High-Cost Support – Rate Comparability (1000)

Filing Regulations: 47 C.F.R. § 54.313(a)(2); 47 C.F.R. § 54.313(a)(3)

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)(2).

CETCs participating in the Alaska Plan should certify that their required stand-alone voice plan is (1) substantially similar to a service plan offered by at least one mobile wireless service provider in the cellular market area (CMA) for Anchorage, Alaska, and (2) offered for the same or a lower rate than the matching plan in the CMA for Anchorage.

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)(2).

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)(3).

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.

CETCs participating in the Alaska Plan should certify that their one service plan that offers broadband data services, if they offer such plans, is (1) substantially similar to a service plan offered by at least one mobile wireless service provider in the cellular market area (CMA) for Anchorage, Alaska, and (2) offered for the same or a lower rate than the matching plan in the CMA for Anchorage.

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)(3).

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) and is not applicable to CETCs receiving Alaska Plan support pursuant to section 54.317.

For non-Alaska carriers, if your response to Line 1100 is “no” then complete Line 1130. If your response is “yes’ then no further action is required.

Alaska Plan Rate-of-Return carriers, whether answering “yes” or “no” to Line 1100, will need to respond to Line 1140.

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). This question is not applicable to companies receiving Alaska Plan support.

Line 1140 – Alaska Plan Satellite Backhaul Certification: If your company is a rate-of-return carrier receiving Alaska Plan support pursuant to section 54.306, respond (either yes, no, or not applicable) to denote whether, in the portion(s) of your study area that relies exclusively on satellite backhaul, your company is providing service consistent with its approved performance plan. See 47 C.F.R. § 54.313(g).

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.

Annual Reporting by Price Cap Carriers Additional Documentation (2005)

Filing Regulations: 47 C.F.R. § 54.313 (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 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: 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).

Line 2018 – Connect America Phase II - Community Anchor Institutions: 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 1st following full implementation of this requirement, 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 model-based 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 1st 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).

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.

If Line 3007 is visible, then the carrier received legacy high-cost support in the prior year.

Line 3007– Cost Consultant/Third Party: Provide a response (yes or no) to state whether the rate-of-return ETC receiving high-cost support retained any cost consultant and/or cost consulting firm, or other third-party, to prepare financial and operations data disclosures submitted to NECA, USAC, or the Commission in the prior year. These disclosures include those associated with FCC Forms 507, 508, and 509.

If the answer to Line 3007 is yes, then lines 3007A and 3007B should appear.

Line 3007A – Name of Consultant/Third Party: Provide the name(s) of any cost consultant or other third-party retained to prepare financial and operations data disclosures submitted in the prior year to NECA, USAC, or the Commission, as required by 47 C.F.R. § 54.313(f)(4).

Line 3007B – Name of Consultant Firm: If applicable, provide the name(s) of any cost consultant firm associated with the cost consultant named in line 3007A, as required by 47 C.F.R. § 54.313(f)(4).

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 legacy 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 25 Mbps downstream/3 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. If the rate-of-return carrier receives CAM-ACAM support, the carrier must instead certify that it is meeting the relevant reasonable request standard; a rate-of-return carrier receiving Alaska Plan support pursuant to section 54.306 must certify that it is offering broadband service 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 at speeds committed to in its approved performance plan to the locations it has reported pursuant to section 54.316(a), subject to any limitations due to the availability of backhaul as specified in section 54.313(g). 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.

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-of-return 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-of-return 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:

(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-of-return 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.

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.

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 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).

Annual Reporting by Alaska Plan Participants - Additional Documentation (5005)

Filing Regulations: 47 C.F.R. § 54.313(f)(3); 47 C.F.R. § 54.313(l)

Purpose: Consolidates reporting requirements for recipients of Alaska Plan support.

Line 5010 – Alaska Plan Participation: Does the reporting carrier participate in the Alaska Plan (yes/no)? Participants in the Alaska Plan have additional reporting requirements per sections 54.313(f)(3) and 54.313(l).

If your response to Line 5010 is “yes” then complete Line 5011 (rate-of-return carriers) or Line 5012 (wireless/CETC). If your response is “no” then no further entries are required on this screen.

Line 5011 – Newly Available Terrestrial or other Satellite Backhaul (RoR Carriers): Please indicate, yes or no, whether any terrestrial backhaul or other satellite backhaul became commercially available in the previous calendar year in areas previously served exclusively by performance-limiting satellite backhaul. This is required per section 54.313(f)(3).

Line 5012 – Newly Available Terrestrial or other Satellite Backhaul (CETC Carriers): If the filing carrier identified in its approved performance plans that it relies exclusively on satellite backhaul for a certain portion of the population in its service area, indicate (yes/no) whether any terrestrial backhaul or other satellite backhaul became commercially available in the previous calendar year in areas that were previously served exclusively by satellite backhaul. This is required per section 54.313(l).

If your response to Line 5011 or 5012 is “yes” then complete Line 5013 (rate-of-return carriers AND wireless/CETC carriers). If your response is “no” then no further entries are required on this screen.

Line 5013 – Column a - Description of Backhaul Technology: Please provide a description of the backhaul technology. This is required per sections 54.313(f)(3) and 54.313(l)(1)(i).

Line 5013 – Column b - Date Backhaul Available: Please provide the date at which that backhaul was made commercially available to the carrier. This is required per sections 54.313(f)(3) and 54.313(l)(1)(ii).

Line 5013 – Column c – Newly Served Locations or Population: Please provide the number of locations (RoR participants) or the number of population (CETC participants) that are newly served by the new terrestrial backhaul or other satellite backhaul. This is required per section 54.313(f)(3) for rate-of-return providers and per section 54.313(l)(1)(iii) for CETC providers.

Line 5014a - Mobile carriers’ reasonably comparable rate demonstration, at the end of their 5- and 10-year milestones - Mobile carriers that are receiving support from the Alaska Plan must demonstrate compliance at the end of the five-year milestone and 10-year milestone and may do this by showing that its required stand-alone voice plan, and one service plan that offers broadband data services, if it offers such plans, are:

1. Substantially similar to a service plan offered by at least one mobile wireless service provider in the cellular market area (CMA) for Anchorage, Alaska, and

2. Offered for the same or a lower rate than the matching plan in the CMA for Anchorage.

This is required by 54.308(d).

Line 5014b – Please Provide Attachment – If Yes, attach a document demonstrating compliance with the 5-year milestone. If No, attach an explanation of non-compliance.

Other Notes: Please note that when new backhaul becomes commercially available, per section 54.313(f)(3), carriers should, within 12 months, certify that they are offering broadband service 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. This certification is not part of this form submission and should instead be submitted in WC Docket No. 16-271.

In addition, wireless carriers, per section 54.313(l)(1)(iv), have additional requirements outside the submission of this form. To the extent the funding recipient has not already committed to providing 4G LTE at 10/1 Mbps to the population served by the newly available backhaul by the end of the plan term, submit a revised performance commitment factoring in the availability of the new backhaul option no later than the due date of the FCC Form 481 in which carriers have certified that such backhaul became commercially available. This part of the requirement is not part of this form submission and should instead be submitted in WC Docket No. 16-271.

Annual Reporting by Phase II Auction Support Recipients - Additional Documentation (6005)

Line 6010 – Phase II Auction Capital Expenditures: Starting the first July 1st after receiving support until the July 1st after the recipient's support term has ended, recipients of Phase II auction support, including carriers in New York that receive Phase II auction support, must submit the total amount of support, if any, the recipient used for capital expenditures in the previous calendar year. This is required by 47 C.F.R. § 54.313(e)(2)(i)(B).

Line 6011 – Phase II Auction Available Funds Certification: Please provide a response (either yes or no) to this certification request for any recipient of Phase II auction support, including carriers in New York that receive Phase II auction support, that the recipient has available funds for all project costs that will exceed the amount of support that will be received for the next calendar year. This certification must be provided starting the first July 1^st after receiving support until the recipient’s penultimate year of support, as required by required by 47 C.F.R. § 54.313(e)(2)(ii).

Line 6012A – Phase II Auction Community Anchor Institutions: Recipients of Connect America Phase II auction 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)(2)(i)(A).

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.

If your response to Line 6012A is “yes – attach new community anchors” then complete Line 6012B.

Line 6012B – Community Anchor Institutions: Please attach a document which contains the community anchor institution details as required by 47 C.F.R. § 54.313(e)(2)(i)(A).

Line 6013 – Phase II Auction FCC Form 470 Postings: For the filing due July 1st following full implementation of this requirement, please provide a response (either yes, no, or not applicable) to this certification request. Recipients of Connect America Phase II auction support must respond affirmatively that they 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 auction 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)(2)(i)(C). This certification will not be required until the July 1st 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 6014 – Phase II Auction Post-Final Deployment Milestone Performance Certification: Starting the first July 1st after a Phase II auction recipient meets the final service milestone in 47 C.F.R. § 54.310(c) until the July 1st after the Phase II auction recipient’s support term has ended, please provide a response (either yes, no, or not applicable) that the Phase II auction-funded network that the Phase II auction recipient operated in the prior year meets the relevant performance requirements in 47 C.F.R. § 54.309. This filing is required by 47 C.F.R. § 54.313(e)(2)(iii).

Annual Reporting by Phase-Down Support Recipients - Additional Documentation (7005)

Line 7010 – Phase-Down Support Certification: Please provide a response (either yes, no, or not applicable) to this certification request. Any price cap carrier or fixed competitive eligible telecommunications carrier that elects to continue receiving support pursuant to §54.312(d) or §54.307(e)(2)(iii) starting July 1, 2020 and annually thereafter on July 1 for each subsequent year they receive such support, that all such support the company received in the previous year was used to provide voice service throughout the high-cost and extremely high-cost census blocks where they continue to have the federal high-cost eligible telecommunications carrier obligation to provide voice service pursuant to §54.201(d) at rates that are reasonably comparable to comparable offerings in urban areas. This certification is required by 47 C.F.R. § 54.313(m).

Annual Reporting by Uniendo a Puerto Rico Fun d Stage 2 Fixed and Mobile - Additional Documentation (8005)

Line 8010 – Uniendo a Puerto Rico Fund Stage 2 Fixed - Capital Expenditures: Starting the first July 1st after receiving support until the July 1st after the recipient's support term has ended, recipients of Uniendo a Puerto Rico Fund Stage 2 fixed support must submit the total amount of support, if any, the recipient used for capital expenditures in the previous calendar year. This is required by 47 C.F.R. § 54.313(e)(2)(i)(B).

Line 8011 – Uniendo a Puerto Rico Fund Stage 2 Fixed - Available Funds Certification: Please provide a response (either yes or no) to this certification request for any recipient of Uniendo a Puerto Rico Fund Stage 2 fixed support that the recipient has available funds for all project costs that will exceed the amount of support that will be received for the next calendar year. This certification must be provided starting the first July 1^st after receiving support until the recipient’s penultimate year of support, as required by required by 47 C.F.R. § 54.313(e)(2)(ii).

Line 8012A – Uniendo a Puerto Rico Fund Stage 2 Fixed - Community Anchor Institutions: Recipients of Uniendo a Puerto Rico Fund Stage 2 fixed 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)(2)(i)(A).

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.

If your response to Line 8012A is “yes – attach new community anchors” then complete Line 8012B.

Line 8012B – Community Anchor Institutions: Please attach a document which contains the community anchor institution details as required by 47 C.F.R. § 54.313(e)(2)(i)(A).

Line 8013 – Uniendo a Puerto Rico Fund Stage 2 Fixed - FCC Form 470 Postings: For the filing due July 1st following full implementation of this requirement, please provide a response (either yes, no, or not applicable) to this certification request. Recipients of Uniendo a Puerto Rico Fund Stage 2 fixed support must respond affirmatively that they 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 Uniendo a Puerto Rico Fund Stage 2 fixed 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)(2)(i)(C). This certification will not be required until the July 1st 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 8014 – Uniendo a Puerto Rico Fund Stage 2 Fixed - Post-Final Deployment Milestone Performance Certification: Starting the first July 1st after a Uniendo a Puerto Rico Fund Stage 2 fixed support recipient meets its final service milestone until the July 1st after the support recipient’s support term has ended, please provide a response (either yes, no, or not applicable) that the Uniendo a Puerto Rico Fund Stage 2-funded network that the support recipient operated in the prior year meets the relevant performance requirements in 47 C.F.R. § 54.309. This filing is required by 47 C.F.R. § 54.313(e)(2)(iii).

Line 8020 – Uniendo a Puerto Rico Fund Stage 2 Fixed - Support Reimbursement Certification: Please provide a response (either yes or no) to this certification request. All Stage 2 Support recipients must certify that support was not used for costs that are (or will be) reimbursed by other sources of support. This certification is required by 47 C.F.R. § 54.313(n).

Line 8030 – Uniendo a Puerto Rico Fund Stage 2 Fixed - Disaster Preparedness and Response Documentation: Please provide a response if carrier is compliant with 54.313(n) as required by 54.1515(a)-(c) (either yes or no). All Stage 2 support recipients must update their Disaster Prearation and Response Plan when they make material changes to internal processes or responsible staff and share the updated Disaster Preparation and Response Plan with the Bureau within 10 business days. Support recipients are also required to certify annually to USAC that they have recently reviewed the Disaster Preparation and Response Plan and considered whether any changes or revisions were necessary. This certification is required by 47 C.F.R. § 54.313(n).

Line 8040 – Uniendo a Puerto Rico Fund Stage 2 Mobile - Support Reimbursement Certification: Please provide a response (either yes or no) to this certification request. All Stage 2 Support recipients must certify that support was not used for costs that are (or will be) reimbursed by other sources of support. This certification is required by 47 C.F.R. § 54.313(n).

Line 8050 – Uniendo a Puerto Rico Fund Stage 2 Mobile - Disaster Preparedness and Response Documentation: Please provide a response if carrier is compliant with 54.313(n) as required by 54.1515(a)-(c) (either yes or no). All Stage 2 support recipients must update their Disaster Preparation and Response Plan when they make material changes to internal processes or responsible staff and share the updated Disaster Preparation and Response Plan with the Bureau within 10 business days. Support recipients are also required to certify annually to USAC that they have recently reviewed the Disaster Preparation and Response Plan and considered whether any changes or revisions were necessary. This certification is required by 47 C.F.R. § 54.313(n).

Line 8060 – Uniendo a Puerto Rico Fund Stage 2 Mobile - Mobile Disbursements Certification: Please provide a response (either yes or no) to this certification request. Recipients of Uniendo a Puerto Rico Fund Stage 2 mobile support must certify compliance with all requirements for receipt of such support to continue receiving Stage 2 mobile disbursements. This certification is required by 47 C.F.R. § 54.313(o).

Annual Reporting by Connect US Virgin Islands Fund Stage 2 Fixed and Mobile - Additional Documentation (9005)

Line 9010 – Connect USVI Fund Stage 2 Fixed - Capital Expenditures: Starting the first July 1st after receiving support until the July 1st after the recipient's support term has ended, recipients of Connect USVI Fund Stage 2 fixed support must submit the total amount of support, if any, the recipient used for capital expenditures in the previous calendar year. This is required by 47 C.F.R. § 54.313(e)(2)(i)(B).

Line 9011 – Connect USVI Fund Stage 2 Fixed - Available Funds Certification: Please provide a response (either yes or no) to this certification request for any recipient of Connect USVI Fund Stage 2 fixed support that the recipient has available funds for all project costs that will exceed the amount of support that will be received for the next calendar year. This certification must be provided starting the first July 1^st after receiving support until the recipient’s penultimate year of support, as required by required by 47 C.F.R. § 54.313(e)(2)(ii).

Line 9012A – Connect USVI Fund Stage 2 Fixed - Community Anchor Institutions: Recipients of Connect USVI Fund Stage 2 fixed 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)(2)(i)(A).

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.

If your response to Line 9012A is “yes – attach new community anchors” then complete Line 9012B.

Line 9012B – Community Anchor Institutions: Please attach a document which contains the community anchor institution details as required by 47 C.F.R. § 54.313(e)(2)(i)(A).

Line 9013 – Connect USVI Fund Stage 2 Fixed - FCC Form 470 Postings: For the filing due July 1st following full implementation of this requirement, please provide a response (either yes, no, or not applicable) to this certification request. Recipients of Connect USVI Fund Stage 2 fixed support must respond affirmatively that they 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 Connect USVI Fund Stage 2 fixed 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)(2)(i)(C). This certification will not be required until the July 1st 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 9014 – Connect USVI Fund Stage 2 Fixed - Post-Final Deployment Milestone Performance Certification: Starting the first July 1st after a Connect USVI Fund Stage 2 fixed support recipient meets its final service milestone until the July 1st after the support recipient’s support term has ended, please provide a response (either yes, no, or not applicable) that the Connect USVI Fund Stage 2-funded network that the support recipient operated in the prior year meets the relevant performance requirements in 47 C.F.R. § 54.309. This filing is required by 47 C.F.R. § 54.313(e)(2)(iii).

Line 9020 – Connect USVI Fund Stage 2 Fixed - Support Reimbursement Certification: Please provide a response (either yes or no) to this certification request. All Stage 2 Support recipients must certify that support was not used for costs that are (or will be) reimbursed by other sources of support. This certification is required by 47 C.F.R. § 54.313(n).

Line 9030 – Connect USVI Fund Stage 2 Fixed - Disaster Preparedness and Response Documentation: Please provide a response if carrier is compliant with 54.313(n) as required by 54.1515(a)-(c) (either yes or no). All Stage 2 support recipients must update their Disaster Preparation and Response Plan when they make material changes to internal processes or responsible staff and share the updated Disaster Preparation and Response Plan with the Bureau within 10 business days. Support recipients are also required to certify annually to USAC that they have recently reviewed the Disaster Preparation and Response Plan and considered whether any changes or revisions were necessary. This certification is required by 47 C.F.R. § 54.313(n).

Line 9040 – Connect USVI Fund Stage 2 Mobile - Support Reimbursement Certification: Please provide a response (either yes or no) to this certification request. All Stage 2 support recipients must certify that support was not used for costs that are (or will be) reimbursed by other sources of support. This certification is required by 47 C.F.R. § 54.313(n)

Line 9050 – Connect USVI Fund Stage 2 Mobile - Disaster Preparedness and Response Documentation: Please provide a response if carrier is compliant with 54.313(n) as required by 54.1515(a)-(c) (either yes or no). All Stage 2 support recipients must update their Disaster Preparation and Response Plan when they make material changes to internal processes or responsible staff and share the updated Disaster Preparation and Response Plan with the Bureau within 10 business days. Support recipients are also required to certify annually to USAC that they have recently reviewed the Disaster Preparation and Response Plan and considered whether any changes or revisions were necessary. This certification is required by 47 C.F.R. § 54.313(n).

Line 9060 – Connect USVI Fund Stage 2 Mobile - Mobile Disbursements Certification: Please provide a response (either yes or no) to this certification request. Recipients of Connect US Virgin Islands Fund Stage 2 mobile support must certify compliance with all requirements for receipt of such support to continue receiving Stage 2 mobile disbursements. This certification is required by 47 C.F.R. § 54.313(o).

Annual Reporting by Rural Digital Opportunity Fund Participants - Additional Documentation (10005)

Line 10010 – Rural Digital Opportunity Fund - Capital Expenditures: Starting the first July 1st after receiving support until the July 1st after the recipient's support term has ended, recipients of Rural Digital Opportunity Fund support must submit the total amount of support, if any, the recipient used for capital expenditures in the previous calendar year. This is required by 47 C.F.R. § 54.313(e)(2)(i)(B).

Line 10011 – Rural Digital Opportunity Fund - Available Funds Certification: Please provide a response (either yes or no) to this certification request for any recipient of Rural Digital Opportunity Fund support that the recipient has available funds for all project costs that will exceed the amount of support that will be received for the next calendar year. This certification must be provided starting the first July 1st after receiving support until the recipient’s penultimate year of support, as required by 47 C.F.R. § 54.313(e)(2)(ii).

Line 10012A – Rural Digital Opportunity Fund - Community Anchor Institutions: Recipients of Rural Digital Opportunity Fund 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)(2)(i)(A). 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.

If your response to Line 10012A is “yes – attach new community anchors” then complete Line 10012B.

Line 10012B – Community Anchor Institutions: Please attach a document which contains the community anchor institution details as required by 47 C.F.R. § 54.313(e)(2)(i)(A).

Line 10013 – Rural Digital Opportunity Fund - FCC Form 470 Postings: For the filing due July 1st following full implementation of this requirement, please provide a response (either yes, no, or not applicable) to this certification request. Recipients of Rural Digital Opportunity Fund must respond affirmatively that they 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 Rural Digital Opportunity Fund, and that such bids were at rates reasonable comparable to rates charged to eligible schools and libraries in urban areas for Instructions for Completing FCC Form 481 OMB Control No. 3060-0986 (High-Cost) OMB Control No. 3060-0819 (Low-Income) November 2020 Page 44 comparable offerings. This filing is required by 47 C.F.R. § 54.313(e)(2)(i)(C). This certification will not be required until the July 1st 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 10014 – Rural Digital Opportunity Fund - Post-Final Deployment Milestone Performance Certification: Starting the first July 1st after a Rural Digital Opportunity Fund recipient meets its final service milestone until the July 1st after the support recipient’s support term has ended, please provide a response (either yes, no, or not applicable) that the Rural Digital Opportunity Fund-funded network that the support recipient operated in the prior year meets the relevant performance requirements in 47 C.F.R. § 54.309. This filing is required by 47 C.F.R. § 54.313(e)(2)(iii).

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).

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.

• 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).

Certify Filing – Reporting Carrier Officer:

Annual Certification in compliance with §54.9: Please provide a response, either yes or no, to whether the carrier certifies compliance with section 54.9, prohibiting the use of universal support to purchase, obtain, maintain, improve, modify, or otherwise support any equipment or services produced or provided by any company designated by the Federal Communications Commission as posing a national security threat to the integrity of communications networks or the communications supply chain since the effective date of the designations. Consistent with the 2019 Supply Chain Order (FCC 19-121), all recipients of USF support (E-Rate, Lifeline, Rural Healthcare, and High Cost) must annually certify compliance with section 54.9. If no, the carrier must attach a copy of the FCC order granting a waiver of section 54.9 of the rules, or a PDF copy of the pending waiver request submitted to the FCC.

Annual Certification in compliance with §54.10: Please provide a response, either yes or no, to whether the carrier certifies compliance with section 54.10, that no Federal subsidy made available through a program administered by the Commission that provides funds to be used for the capital expenditures necessary for the provision of advanced communications services has been or will be used to purchase, rent, lease, or otherwise obtain, any covered communications equipment or service, or maintain any covered communications equipment or service previously purchased, rented, leased, or otherwise obtained. If no, the carrier must attach a copy of the FCC order granting a waiver of section 54.10 of the rules, or a PDF copy of the pending waiver request submitted to the FCC.

Effective Q1 2023

Annual Certification in compliance with §54.11: Please provide a response, either yes or no (but I am participating in the reimbursement program and the removal, replacement, and disposal term has not expired), to whether the carrier certifies compliance with section 54.11, and does not use covered communications equipment or services published on the Covered List.

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). See also Connect America Fund; ETC Annual Reports and Certifications, Report and Order, 32 FCC Rcd 5944 (2017) (ETC Reporting Streamlining Order) (streamlining and reorganizing section 54.313(a) 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).

3 See generally ETC Reporting Streamlining Order, 32 FCC Rcd 5944.

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

5 See 47 C.F.R. § 54.313.

6 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.

7 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).

8 See Connect America Fund; ETC Annual Reports and Certifications, Report and Order, 32 FCC Rcd 5944, 5948, para. 15 (2017) (instructing USAC to serve as the single source of data collection for the FCC Form 481).

9 47 C.F.R. § 54.313(a)(1); see also 47 C.F.R. § 54.202(a)(2).

10 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).

11 47 C.F.R. § 54.313(a)(4).

12 47 C.F.R. § 54.313(a)(5); 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).

13 47 C.F.R. § 54.313(a)(2).

14 47 C.F.R. § 54.313(a)(6).

15 47 C.F.R. § 54.313(a)(3).

16 47 C.F.R. § 54.313(c); see also 47 C.F.R. § 54.312(a).

17 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.

18 47 C.F.R. § 54.313(e).

19 47 C.F.R. § 54.313(f).

20 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).

21 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).

22 47 C.F.R. § 54.422.

23 47 C.F.R. § 54.422(c).

24 47 C.F.R. § 54.422(a)(1).

25 47 C.F.R. § 54.422(a)(2).

26 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.

27 47 C.F.R. § 54.9.

28 See Protecting Against National Security Threats to the Communications Supply Chain Through FCC Programs, WC Docket No. 18-89, Report and Order, Further Notice of Proposed Rulemaking, and Order, 34 FCC Rcd 11423, 11454, para. 79 (2019) (2019 Supply Chain Order).

29 47 C.F.R. § 54.313(a)(5); 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).

	Page 34