Telecommunications Relay Services and Sppech-to-Speech Services for Individuals with Hearing and Speech Disabilities

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Overview

PRA
Instructions
Appendix Instructions
Filing Information
Filing Notes
Flat Rate Revenue
Per Minute Revenue
Add. Revenue Paid To Provider
Costs Paid By Provider
Demand
VRS Expenses
IP Relay Expenses
IP CTS CA Expenses
IP CTS ASR Expenses
CA Stats

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Sheet 1: PRA

	TRS Fund Annual Provider Filing	DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
	PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS
	The FCC is authorized under the Communications Act of 1934, as amended, to collect the information we request in this form. If we believe there may be a violation or a potential violation of a FCC statute, regulation, rule or order, your certification may be referred to the Federal, state or local agency responsible for investigating, prosecuting, enforcing, or implementing the statute, rule, regulation, or order. In certain cases, the information in your certification may be disclosed to the Department of Justice or a court or adjudicative body when a) the FCC; or b) any employee of the FCC; or c) the United States Government is a party of a proceeding before the body or has an interest in the proceeding.
	We have estimated that this collection of information will take 10.0 hours annually. Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, Office of Managing Director, AMD-PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060-0463). We will also accept your PRA comments if you send an e-mail to PRA@fcc.gov.
	Please DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0463.
	THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93- 579, DECEMBER 31, 1974, 5 U.S.C. SECTION 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

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Sheet 2: Instructions

	TRS Fund Annual Provider Filing Instructions							DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
	Below are general instructions for completing this filing workbook. For complete instructions, please reference the Annual Filing - Provider Instructions document. Any questions should be submitted to the Rolka Loube Provider Help Desk
	Rolka Loube Provider Help Desk
	Worksheet	Instructions
	Filing Information	Use the provided areas to supply provider, filing year, preparer, and attesting officer information.
	Filing Notes	Summarize any service improvements, forecasting methodologies and changes to relay demand.
	Flat Rate Revenue	For TTY, STS, or CTS providers, supply requested data for flat rate service contracts.
	Per Minute Revenue	For TTY, STS, or CTS providers, supply requested data for per minute rate service contracts.
	Add. Revenue Paid To Provider	Supply requested data for revenue received for programs that support TTY, STS, and/or CTS above those associated with provisioning the service (i.e., outreach, billing, administration).
	Add. Costs Paid by Provider	Supply requested data for costs paid for incentives or services for which the state was not required to pay
	Demand	For VRS, IP Relay, IP CTS CA, or IP CTS ASR providers, supply two years of historical and two years of projected demand for each service.
	VRS Expenses	For expenses associated with provisioning the service, supply two years of historical and two years of projected expenses for each category/subcategory. See descriptions of the expense subcategories below.
	IP Relay Expenses
	IP CTS CA Expenses
	IP CTS ASR Expenses
	CA Stats	For all IP-based TRS services that require the use of a communications assistant (CA), for all services, supply two years of actual and two years of projected CA employment stats.
	IP Based Expense Categories/Subcategories
	Category	Subcategory		Description
	A. Annual Recurring Fixed/Semi-Variable Expenses	1. Rent		Annual payments solely for land and/or buildings rented for the provision of the TRS service, including the rent of office space used by administrative employees.
		2. Utilities		Allowable expenses associated with land and buildings used for the provision of the TRS service, such as water, sewerage, fuel, T1, trunk lines, internet connectivity, internet service, VoIP service, and power. Telephone service expenses, such as center toll-free numbers, and local and foreign exchange should be included here along with related E911 allowed expenses. Please see appendix instructions for reporting total, allowable, and non-allowable E911 and numbering expenses.
		3. Building Maintenance		Expenses for maintenance and repair used for the provision of the TRS service, including maintenance of office buildings.
		4. Property Tax		Taxes paid on property owned and used for the provision of the TRS service.
		5. Furniture		Lease or rental expenses associated with furnishings used for the provision of the TRS service.
		6. Office Equipment		Lease or rental expenses associated with office equipment used for the provision of the TRS service.
	B. Recurring Variable Expenses ( Direct TRS Operation Expenses)	1. Salaries & Benefits – Relay Center: CA/Interpreting staff		CA and interpreter staff compensation such as wages, salaries, commissions, bonuses, incentive awards, and termination payments; payroll-related benefits paid on behalf of employees, such as pensions, savings plans, workers’ compensation required by law, insurance plans (life, hospital, medical, dental, vision); and social security and other payroll taxes. Include expenses associated with individually contracted or sole proprietor interpreters and CAs. The FCC prohibits incentives paid to CAs and interpreters for the number of calls or the number of minutes billed.
		2. Salaries & Benefits – Relay Center: Management staff		Relay center managers & supervisor compensation such as wages, salaries, commissions, bonuses, incentive awards, and termination payments; payroll-related benefits paid on behalf of employees, such as pensions, savings plans, workers’ compensation required by law, insurance plans (life, hospital, medical, dental, vision); and social security and other payroll taxes.
		3. Salaries & Benefits – Relay Center: Relay Center staff		Relay center staff compensation such as wages, salaries, commissions, bonuses, incentive awards and termination payments; payroll-related benefits paid on behalf of employees, such as pensions, savings plans, workers’ compensation required by law, insurance plans (life, hospital, medical, dental, vision); and social security and other payroll taxes.
		4. Telecommunications Expenses		Expenses associated with inspecting, testing, analyzing and correcting trouble; repairing or reporting on telecommunications plant (switching, transmission, operator, cable, and wire) to determine need for repair, replacements, rearrangements, and changes; expenses for activities, such as controlling traffic flow, administering traffic measuring and monitoring devices, assigning equipment and load balancing, collecting and summarizing traffic data, administering trunking equipment and facilities, automatic call distributor, and assigning interoffice facilities and circuit layout work.
		5. Relay Center Expenses		Expenses not included in other accounts, such as providing food services, libraries, archives, mail service, procuring office equipment, office supplies, materials, and repair.
	C. Administrative Expenses	1. Financial/Accounting		Expenses incurred in providing accounting and financial services. Accounting services include payroll and disbursements, property accounting, capital recovery, regulatory accounting, tax accounting, auditing, capital and operating budget and control, and general accounting. Financial services include banking operations, cash management, and benefit investment fund management, etc.
		2. Legal/Regulatory		Expenses incurred for legal and regulatory services. Legal services include conducting and coordinating litigation, providing guidance on regulatory and labor matters, court expenses, filing fees, cost of counsel, etc. Regulatory services include preparing and presenting information for regulatory purposes, such as responding to this data request and the cost of registering customers in the User Registration Database (URD).
		3. Engineering		Expenses incurred in the general day-to-day engineering operation of the TRS telecommunications plant and/or IP network.
		4. Research and Development		Expenses incurred for research and development required to meet applicable non-waived mandatory minimum standards. Please see appendix instructions for reporting total R&D expenses and R&D expenses above and beyond meeting mandatory minimum standards.
		5. Operations Support		Expenses that ensure the sustainability of service including troubleshooting, customer service, and technical support.
		6. Human Resources		Expenses incurred in performing personnel administration activities, including recruiting, hiring, forecasting, planning, training, scheduling, counseling employees, and reporting.
		7. Billing		Administrative expenses of rating and providing billing information to interexchange and exchange carriers, if not recovered by other means.
		8. Contract Management		Expenses of managing activities required by the provider contracts.
		9. Risk Management		Management expenses associated with workers’ compensation, payments in settlement of accident and damage claims, insurance premiums against losses and damages, sickness, and disability payment, etc.
		10. Other Corporate Overheads		Other administrative expenses of providing TRS. All costs over $10,000 should be itemized. Indirect overhead costs are not reasonable costs of providing TRS. Appropriate overhead costs are those costs that are directly related to and directly support the provision of relay service. Indirect overhead costs may not be allocated to TRS by an entity that provides services other than TRS based on the percentage of the entity’s revenues that are derived from the provision of TRS.
	D. Depreciation Associated with Capital Investments	1. Furniture & Fixtures		Depreciation expense on furniture and/or fixtures.
		2. Telecommunications Equipment		Depreciation expense associated with capitalized expenses of telecommunication equipment including switching equipment, operator services equipment, cable and wire facilities, transmission equipment, and power equipment.
		3. Leasehold		Amortization of leasehold improvements – improvements which become a permanent part of a building, like walls or carpeting.
		4. Software		Amortization expenses associated with capitalized software.
		5. Other Capitalized		Depreciation expense not accounted for in other categories.
	E. Other TRS Expenses	1. Marketing/Advertising Expenses		Expenses associated with promoting provided services and/or identifying the needs of users excluding costs associated with providing user incentives.
		2. Outreach Expenses		Expenses associated with educating the public on the TRS service.
		3. Subcontractor		Third-party costs associated with two or more individuals providing IP-based TRS services for the provider under a single contract. Please see appendix instructions for reporting and allocating subcontractor costs to the appropriate categories and subcategories. Subcontractor costs not properly allocated shall be treated as non-allowable costs.
		4. License Fees paid to a third party		Expenses associated with payments to a third-party for use of technology, software, and/or equipment.
		5. License Fees paid to an affiliate		Expenses associated with payments to an affiliate for use of technology, software, and/or equipment.
		6. Software		Expenses related to in-house development/maintenance of software and/or license fees associated with commercial software as required to meet mandatory minimum standards. Please see appendix instructions for reporting total software expenses including software on off-the-shelf CPE and software expenses above and beyond meeting mandatory minimum standards.
		7. Customer Premises Equipment		Expenses associated with hardware and software, including installation, maintenance, and testing as well as expenses associated with software installed on proprietary CPE.
		8. Other		Any expenses associated with the provisioning of the TRS service that has not been reported previously.
	F. Capital Investmens	1. Furniture & Fixtures		Year-end net book value of capital investment on furniture and/or fixtures.
		2. Telecommunications Equipment		Year-end net book value of capital investment associated with telecommunication equipment including switching equipment, operator services equipment, cable and wire facilities, transmission equipment, and power equipment.
		3. Leasehold		Year-end net book value of capital investment of leasehold improvements – improvements which become a permanent part of a building, like walls or carpeting.
		4. Software		Year-end net book value of capital investments associated with capitalized software. Please see appendix instructions for reporting total software expenses including software on off-the-shelf CPE and software expenses above and beyond meeting mandatory minimum standards.
		5. Other Capitalized		Year-end net book value of capital investments not accounted for in other categories.

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Sheet 3: Appendix Instructions

TRS Fund Annual Provider Filing Appendix Instructions

DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours

Data may be entered on the worksheet, or a document may be embedded in the worksheet. Additional worksheets may be added as needed. To assist with reviewing the required appendix data, please identify the worksheet and/or filename that contains the referenced appendix data. Required appendix data is described in the table below.

Cost Category/Subcategory and required data

Worksheet/File Name

A. Recurring Fixed/Semi-Variable Expenses

1) For expenses that are provisioned jointly with the expenses for other telecommunications relay services, provide the following:

Total company expenses

Description of how the total expenses are allocated among the TRS services and between TRS and non-TRS services

Percent allocation for each service

2) Seperately identify allowable and non-allowable costs associated with E911 and numbering for IP based TRS for each of the following categories:

Ensuring that database information is properly and timely updated and maintained

Processing and transmitting calls made to ten-digit numbers

Routing emergency calls to an appropriate Public Safety Answering Point

Other implementation-related tasks directly related to facilitating ten-digit numbering and emergency call handling

Consumer outreach and education related to the requirements and services

Any costs associated with obtaining numbers

B. Recurring Variable Expenses (Direct TRS Operation Expenses)

1) Provide, by call center, job descriptions/titles and compensation including salaries and benefits and average number of staff within the following categories:

CA and/or interpreter employees

Sole proprietor and individually operated LLCs offering CA and interpreter services

Relay center management and/or supervisors

Relay center staff

2) Summarize expenses exceeding $10,000 including vendor, description of goods/services, and expense amounts for the following categories:

Telecommunication expenses

Relay center expenses

C. Administrative Expenses

1) Provide job descriptions/titles and compensation including salaries and benefits and average number of staff within the following categories:

Finance/Accounting

Legal/Regulatory

Engineering

Research and development – broken down by platform, software, and CPE; research and development expenses required to meet applicable non-waived mandatory minimum standards and expenses above and beyond meeting mandatory minimum standards shall be broken down into separate amounts.

Operations Support

Human Resources

Billing

Contract Management

Other Corporate Overhead

2) Summarize expenses exceeding $10,000 including vendor, description of goods/services, and expense amounts for the following categories:

Finance/Accounting

Legal/Regulatory

Engineering

Research and Development – broken down by platform, software, and CPE; research and development expenses required to meet applicable non-waived mandatory minimum standards and expenses above and beyond meeting mandatory minimum standards shall be broken down into separate amounts.

Operations Support

Human Resources

Contract Management

Other Corporate Overhead

3) Describe engineering activities

4) Describe research and development projects, and to the extent applicable, explain how they relate to meeting the mandatory minimum standards

5) Provide other expenses incurred in rating and providing billing information to exchange and interexchange carriers if not recovered by other means.

6) Provide a list of officers, senior management, and directors. For individuals listed:

Provide a schedule that shows how their compensation has been assigned between TRS and non-TRS services. For TRS services managed by state programs, provide a schedule that shows how their compensation has been assigned between the Interstate and Intrastate components. For interstate Fund supported services, identify separately expenses assigned to each service.

Indicate if their compensation has been included in any other cost category/subcategory

D. Depreciation Associated with Capital Investment

1) Provide the depreciation method and period applied.

2) Explain departures from traditional depreciation methods

3) Summarize depreciable life, depreciation method, and depreciation expenses by cost subcategory

E. Other TRS Expenses

1) Provide job descriptions/titles and compensation including salaries and benefits and average number of staff within the following categories:

Marketing/Advertising

Outreach

Customer Premise Equipment - sales, installation, and maintenance employees

2) For expenses exceeding $10,000, provide vendor, description of goods/services, and expense amounts for the following categories:

Marketing/Advertising

Outreach

Subcontractor

3) Provide a copy of each subcontractor contract and include contract termination dates, billing rates and billing units, and an allocation of subcontractor expenses by RSDR expense categories and subcategories. Include all data that supports the allocation of subcontractor expenses.

4) Provide a list of items purchased and outline billing rates and biling units for the following categories

License fees paid to a third party

License fees paid to an affiliate

5) Provide the number of Customer Premises Equipment sold, produced, and installed.

6) Provide the costs of CPE provided to consumers. Provide a schedule that breaks out the expenses among its component parts.

7) Provide a schedule of software expenses associated with CPE. Identify separately software expenses related to proprietary CPE and off-the-shelf CPE. Software expenses required to meet mandatory minimum standards and software expenses above and beyond meeting mandatory minimum standards shall be broken down into separate amounts.

8) Provide a schedule identifying and describing any expenses not previously reported in another category.

F. Capital Investments

1) Provide an account of all capital equipment purchased in order to provide each form of TRS. Only include capital investment items that are long term in nature and subject to depreciation. Items such as office supplies should be listed in Section B6.

Itemize investments by: Form of TRS, Equipment class, Gross book values, Accumulated depreciation, Net book values

For equipment used to monitor and supervise call centers that provide multiple TRS services, provide the total company investments, describe how total investments are allocated among the services, and the percent allocation for each service

2) Provide an account of all capitalized expenses associated with software installed on off-the-shelf CPE and capitalized expenses associated with software installed on proprietary CPE shall be broken down into separate amounts. Capitalized expenses associated with software installed on CPE required to meet mandatory minimum standards and capitalized expenses associated with software installed on CPE above and beyond mandatory minimum standards shall be broken down into separate amounts.

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Sheet 4: Filing Information

		TRS Fund Annual Provider Filing					DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
	Provider Name
	Preparer Name
	Preparer's Email Address
	Preparer's Telephone
	Filing Period
	Signed By:
	Senior Officer Name
	Senior Officer Title
	I swear under penalty of perjury that I am _______________________, __________________________, an officer of the above-named reporting entity and that I have examined the foregoing reports and that all requested information has been provided and all statements of fact, are true and accurate.
	Persons willfully making false statements on this form can be punished by fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. §1001.
								Date
	Signature

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Sheet 5: Filing Notes

		TRS Fund Annual Provider Filing					DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
	To assist RolkaLoube in understanding your data, please provide the following information:
	Provide a summary of any changes, activities, and/or improvements since the prior year filing or that are planned for the upcoming program year, which caused or may cause substantial changes in cost and/or demand data.
	Describe the methology used to determine the forecasted minutes for the projected years.
	Describe any characteristics unique to a particular service or changes in the relay services marketplace.

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Sheet 6: Flat Rate Revenue

TRS Fund Annual Provider Filing Flat Rate Revenue

DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours

For each state for which the provider provides TTY, STS, and/or CTS service at a flat rate, supply the following information associated with provision of service minutes.

Jurisdiction

Rate Covers Services

Rate Start

Rate End

Reported as Annual Total or Monthly Rate

Flat Rate Amount

Conversation Minutes Serviced During Rate Period

TTY

STS

CTS

TTY

STS

CTS

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Sheet 7: Per Minute Revenue

			DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
		For each state for which the provider provides TTY, STS, and/or CTS service at a per minute rate, supply the following information.
		Jurisdiction	Service	Rate Start	Rate End	Per Session or Conversation Minute	Per Minute Rate	Minutes Serviced During Rate Period
								Conversation	Session

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Sheet 8: Add. Revenue Paid To Provider

TRS Fund Annual Provider Filing Additional Costs Paid To Provider

DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours

For each state for which the provider provides TTY, STS, and/or CTS service and received funds above those related to provision service minutes, supply the following information.

Jurisdiction

Add. Revenue Covers

Revenue Start

Revenue End

Reported as Annual Total or Monthly Cost

Amount

Program

Other Description

TTY

STS

CTS

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Sheet 9: Costs Paid By Provider

TRS Fund Annual Provider Filing Costs Paid By Provider

DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours

For each state for which the provider provides TTY, STS, and/or CTS service and for which the provider paid for incentives or services the state was not required to pay for, supply the following information.

Jurisdiction

Cost Covers

Cost Start

Cost End

Reported as Annual Total or Monthly Cost

Amount

Description

TTY

STS

CTS

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Sheet 10: Demand

		TRS Fund Annual Provider Filing IP Based Service Provider Demand							DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
		For each IP based service provided by the provider, please supply two years of actual compensated demand and two years of projected compensable demand for the years listed below.
		VRS	Actuals		Projections			IP Relay	Actuals		Projections
		January	0	0	0	0		January	0	0	0	0
		February	0	0	0	0		February	0	0	0	0
		March	0	0	0	0		March	0	0	0	0
		April	0	0	0	0		April	0	0	0	0
		May	0	0	0	0		May	0	0	0	0
		June	0	0	0	0		June	0	0	0	0
		July	0	0	0	0		July	0	0	0	0
		August	0	0	0	0		August	0	0	0	0
		September	0	0	0	0		September	0	0	0	0
		October	0	0	0	0		October	0	0	0	0
		November	0	0	0	0		November	0	0	0	0
		December	0	0	0	0		December	0	0	0	0
		Totals	-	-	-	-		Totals	-	-	-	-
		IP CTS CA	Actuals		Projections			IP CTS ASR	Actuals		Projections
		January	0	0	0	0		January	0	0	0	0
		February	0	0	0	0		February	0	0	0	0
		March	0	0	0	0		March	0	0	0	0
		April	0	0	0	0		April	0	0	0	0
		May	0	0	0	0		May	0	0	0	0
		June	0	0	0	0		June	0	0	0	0
		July	0	0	0	0		July	0	0	0	0
		August	0	0	0	0		August	0	0	0	0
		September	0	0	0	0		September	0	0	0	0
		October	0	0	0	0		October	0	0	0	0
		November	0	0	0	0		November	0	0	0	0
		December	0	0	0	0		December	0	0	0	0
		Totals	-	-	-	-		Totals	-	-	-	-

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Sheet 11: VRS Expenses

		TRS Fund Annual Provider Filing VRS Expense and Capital Investment Data						DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
		For expenses associated with the provisioning of VRS service, provide two years of actual and two years of projected expenses for each category/subcategory.
				Actuals				Projections
		A. Recurring Fixed/Semi-Variable Expenses
	1	1. Rent		$-		$-		$-		$-
	2	2. Utilities		$-		$-		$-		$-
	3	3. Building Maintenance		$-		$-		$-		$-
	4	4. Property Tax (if owned)		$-		$-		$-		$-
	5	5. Furniture (if leased)		$-		$-		$-		$-
	6	6. Office Equipment ( if leased)		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		B. Recurring Variable Expenses (Direct TRS Operation Expenses)
	7	1. Salaries & Benefits - Relay Center: CA/Interpreting Staff		$-		$-		$-		$-
	8	2. Salaries & Benefits - Relay Center: Management		$-		$-		$-		$-
	9	3. Salaries & Benefits - Relay Center Staff		$-		$-		$-		$-
	10	4. Telecommunication Expenses		$-		$-		$-		$-
	11	5. Relay Center Expenses		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		C. Administrative Expenses
	12	1. Financial/Accounting		$-		$-		$-		$-
	13	2. Legal/Regulatory		$-		$-		$-		$-
	14	3 Engineering		$-		$-		$-		$-
	15	4. Research and Development		$-		$-		$-		$-
	16	5. Operations Support		$-		$-		$-		$-
	17	6. Human Resources		$-		$-		$-		$-
	18	7. Billing		$-		$-		$-		$-
	19	8. Contract Management		$-		$-		$-		$-
	20	9. Risk Management		$-		$-		$-		$-
	21	10. Other Corporate Overheads		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		D. Depreciation Associated With Capital Investment
	22	1. Furniture & Fixtures		$-		$-		$-		$-
	23	2. Telecommunications Equipment		$-		$-		$-		$-
	24	3. Leasehold		$-		$-		$-		$-
	25	4. Software		$-		$-		$-		$-
	26	5. Other Capitalized		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		E. Other TRS Expenses
	27	1. Marketing/Advertising Expenses		$-		$-		$-		$-
	28	2. Outreach Expenses		$-		$-		$-		$-
	29	3. Subcontractor Expenses excluding License Fees		$-		$-		$-		$-
	30	4. License Fees paid to a third party		$-		$-		$-		$-
	31	5. License Fees paid to an affiliate		$-		$-		$-		$-
	32	6. Software		$-		$-		$-		$-
	33	7. Customer Premise Equipment		$-		$-		$-		$-
	34	8. Other		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		F. Capital Investments
	35	1. Furniture & Fixtures		$-		$-		$-		$-
	36	2. Telecommunications Equipment		$-		$-		$-		$-
	37	3. Leasehold		$-		$-		$-		$-
	38	4. Software		$-		$-		$-		$-
	39	5. Other Capitalized		$-		$-		$-		$-
		Total		$-		$-		$-		$-

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Sheet 12: IP Relay Expenses

		TRS Fund Annual Provider Filing IP Relay Expense and Capital Investment Data						DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
		For expenses associated with the provisioning of IP Relay service, provide two years of actual and two years of projected costs for each category/subcategory.
				Actuals				Projections
		A. Recurring Fixed/Semi-Variable Expenses
	1	1. Rent		$-		$-		$-		$-
	2	2. Utilities		$-		$-		$-		$-
	3	3. Building Maintenance		$-		$-		$-		$-
	4	4. Property Tax (if owned)		$-		$-		$-		$-
	5	5. Furniture (if leased)		$-		$-		$-		$-
	6	6. Office Equipment ( if leased)		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		B. Recurring Variable Expenses (Direct TRS Operation Expenses)
	7	1. Salaries & Benefits - Relay Center: CA/Interpreting Staff		$-		$-		$-		$-
	8	2. Salaries & Benefits - Relay Center: Management		$-		$-		$-		$-
	9	3. Salaries & Benefits - Relay Center Staff		$-		$-		$-		$-
	10	4. Telecommunication Expenses		$-		$-		$-		$-
	11	5. Relay Center Expenses		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		C. Administrative Expenses
	12	1. Financial/Accounting		$-		$-		$-		$-
	13	2. Legal/Regulatory		$-		$-		$-		$-
	14	3 Engineering		$-		$-		$-		$-
	15	4. Research and Development		$-		$-		$-		$-
	16	5. Operations Support		$-		$-		$-		$-
	17	6. Human Resources		$-		$-		$-		$-
	18	7. Billing		$-		$-		$-		$-
	19	8. Contract Management		$-		$-		$-		$-
	20	9. Risk Management		$-		$-		$-		$-
	21	10. Other Corporate Overheads		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		D. Depreciation Associated With Capital Investment
	22	1. Furniture & Fixtures		$-		$-		$-		$-
	23	2. Telecommunications Equipment		$-		$-		$-		$-
	24	3. Leasehold		$-		$-		$-		$-
	25	4. Software		$-		$-		$-		$-
	26	5. Other Capitalized		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		E. Other TRS Expenses
	27	1. Marketing/Advertising Expenses		$-		$-		$-		$-
	28	2. Outreach Expenses		$-		$-		$-		$-
	29	3. Subcontractor Expenses excluding License Fees		$-		$-		$-		$-
	30	4. License Fees paid to a third party		$-		$-		$-		$-
	31	5. License Fees paid to an affiliate		$-		$-		$-		$-
	32	6. Software		$-		$-		$-		$-
	33	7. Customer Premise Equipment		$-		$-		$-		$-
	34	8. Other		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		F. Capital Investments
	35	1. Furniture & Fixtures		$-		$-		$-		$-
	36	2. Telecommunications Equipment		$-		$-		$-		$-
	37	3. Leasehold		$-		$-		$-		$-
	38	4. Software		$-		$-		$-		$-
	39	5. Other Capitalized		$-		$-		$-		$-
		Total		$-		$-		$-		$-

---

Sheet 13: IP CTS CA Expenses

		TRS Fund Annual Provider Filing IP CTS CA Expense and Capital Investment Data						DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
		For expenses associated with the provisioning of IP CTS service for which captions are generated by a CA, provide two years of actual and two years of projected costs for each category/subcategory.
				Actuals				Projections
		A. Recurring Fixed/Semi-Variable Expenses
	1	1. Rent		$-		$-		$-		$-
	2	2. Utilities		$-		$-		$-		$-
	3	3. Building Maintenance		$-		$-		$-		$-
	4	4. Property Tax (if owned)		$-		$-		$-		$-
	5	5. Furniture (if leased)		$-		$-		$-		$-
	6	6. Office Equipment ( if leased)		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		B. Recurring Variable Expenses (Direct TRS Operation Expenses)
	7	1. Salaries & Benefits - Relay Center: CA/Interpreting Staff		$-		$-		$-		$-
	8	2. Salaries & Benefits - Relay Center: Management		$-		$-		$-		$-
	9	3. Salaries & Benefits - Relay Center Staff		$-		$-		$-		$-
	10	4. Telecommunication Expenses		$-		$-		$-		$-
	11	5. Relay Center Expenses		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		C. Administrative Expenses
	12	1. Financial/Accounting		$-		$-		$-		$-
	13	2. Legal/Regulatory		$-		$-		$-		$-
	14	3 Engineering		$-		$-		$-		$-
	15	4. Research and Development		$-		$-		$-		$-
	16	5. Operations Support		$-		$-		$-		$-
	17	6. Human Resources		$-		$-		$-		$-
	18	7. Billing		$-		$-		$-		$-
	19	8. Contract Management		$-		$-		$-		$-
	20	9. Risk Management		$-		$-		$-		$-
	21	10. Other Corporate Overheads		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		D. Depreciation Associated With Capital Investment
	22	1. Furniture & Fixtures		$-		$-		$-		$-
	23	2. Telecommunications Equipment		$-		$-		$-		$-
	24	3. Leasehold		$-		$-		$-		$-
	25	4. Software		$-		$-		$-		$-
	26	5. Other Capitalized		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		E. Other TRS Expenses
	27	1. Marketing/Advertising Expenses		$-		$-		$-		$-
	28	2. Outreach Expenses		$-		$-		$-		$-
	29	3. Subcontractor Expenses excluding License Fees		$-		$-		$-		$-
	30	4. License Fees paid to a third party		$-		$-		$-		$-
	31	5. License Fees paid to an affiliate		$-		$-		$-		$-
	32	6. Software		$-		$-		$-		$-
	33	7. Customer Premise Equipment		$-		$-		$-		$-
	34	8. Other		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		F. Capital Investments
	35	1. Furniture & Fixtures		$-		$-		$-		$-
	36	2. Telecommunications Equipment		$-		$-		$-		$-
	37	3. Leasehold		$-		$-		$-		$-
	38	4. Software		$-		$-		$-		$-
	39	5. Other Capitalized		$-		$-		$-		$-
		Total		$-		$-		$-		$-

---

Sheet 14: IP CTS ASR Expenses

		TRS Fund Annual Provider Filing IP CTS ASR Expense and Capital Investment Data					DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
		For expenses associated with the provisioning of IP CTS service for which captions are generated by ASR, provide two years of actual and two years of projected costs for each category/subcategory.
				Actuals				Projections
		A. Recurring Fixed/Semi-Variable Expenses
	1	1. Rent		$-		$-		$-		$-
	2	2. Utilities		$-		$-		$-		$-
	3	3. Building Maintenance		$-		$-		$-		$-
	4	4. Property Tax (if owned)		$-		$-		$-		$-
	5	5. Furniture (if leased)		$-		$-		$-		$-
	6	6. Office Equipment ( if leased)		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		B. Recurring Variable Expenses (Direct TRS Operation Expenses)
	7	1. Salaries & Benefits - Relay Center: CA/Interpreting Staff		$-		$-		$-		$-
	8	2. Salaries & Benefits - Relay Center: Management		$-		$-		$-		$-
	9	3. Salaries & Benefits - Relay Center Staff		$-		$-		$-		$-
	10	4. Telecommunication Expenses		$-		$-		$-		$-
	11	5. Relay Center Expenses		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		C. Administrative Expenses
	12	1. Financial/Accounting		$-		$-		$-		$-
	13	2. Legal/Regulatory		$-		$-		$-		$-
	14	3 Engineering		$-		$-		$-		$-
	15	4. Research and Development		$-		$-		$-		$-
	16	5. Operations Support		$-		$-		$-		$-
	17	6. Human Resources		$-		$-		$-		$-
	18	7. Billing		$-		$-		$-		$-
	19	8. Contract Management		$-		$-		$-		$-
	20	9. Risk Management		$-		$-		$-		$-
	21	10. Other Corporate Overheads		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		D. Depreciation Associated With Capital Investment
	22	1. Furniture & Fixtures		$-		$-		$-		$-
	23	2. Telecommunications Equipment		$-		$-		$-		$-
	24	3. Leasehold		$-		$-		$-		$-
	25	4. Software		$-		$-		$-		$-
	26	5. Other Capitalized		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		E. Other TRS Expenses
	27	1. Marketing/Advertising Expenses		$-		$-		$-		$-
	28	2. Outreach Expenses		$-		$-		$-		$-
	29	3. Subcontractor Expenses excluding License Fees		$-		$-		$-		$-
	30	4. License Fees paid to a third party		$-		$-		$-		$-
	31	5. License Fees paid to an affiliate		$-		$-		$-		$-
	32	6. Software		$-		$-		$-		$-
	33	7. Customer Premise Equipment		$-		$-		$-		$-
	34	8. Other		$-		$-		$-		$-
		Total		$-		$-		$-		$-
		F. Capital Investments
	35	1. Furniture & Fixtures		$-		$-		$-		$-
	36	2. Telecommunications Equipment		$-		$-		$-		$-
	37	3. Leasehold		$-		$-		$-		$-
	38	4. Software		$-		$-		$-		$-
	39	5. Other Capitalized		$-		$-		$-		$-
		Total		$-		$-		$-		$-

---

Sheet 15: CA Stats

	DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2023 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours
	Please provide data listed below for each service for all CAs employed during the year.
					Actuals				Projections
	VRS
	Average Monthly Full Time CAs				0		0		0		0
	Average Monthly Part Time CAs - On Full Time Equivalent Basis				0		0		0		0
	Total CA Managers				0		0		0		0
	Total Non CA Relay Staff				0		0		0		0
	Total Yearly Number of Available Interpreting Minutes				0		0		0		0
	Total Yearly Number of Session Minutes				0		0		0		0
	Total Yearly Number of Conversation Minutes				0		0		0		0
	Occupancy Percentage				0%		0%		0%		0%
	Utilization Percentage				0%		0%		0%		0%
	IP Relay
	Average Monthly Full Time CAs				0		0		0		0
	Average Monthly Part Time CAs - On Full Time Equivalent Basis				0		0		0		0
	Total CA Managers				0		0		0		0
	Total Non CA Relay Staff				0		0		0		0
	Total Yearly Number of Available Interpreting Minutes				0		0		0		0
	Total Yearly Number of Session Minutes				0		0		0		0
	Total Yearly Number of Conversation Minutes				0		0		0		0
	Occupancy Percentage				0%		0%		0%		0%
	Utilization Percentage				0%		0%		0%		0%
	IP CTS CA
	Average Monthly Full Time CAs				0		0		0		0
	Average Monthly Part Time CAs - On Full Time Equivalent Basis				0		0		0		0
	Total CA Managers				0		0		0		0
	Total Non CA Relay Staff				0		0		0		0
	Total Yearly Number of Available Interpreting Minutes				0		0		0		0
	Total Yearly Number of Session Minutes				0		0		0		0
	Total Yearly Number of Conversation Minutes				0		0		0		0
	Occupancy Percentage				0%		0%		0%		0%
	Utilization Percentage				0%		0%		0%		0%