Form FCC Form 159-W FCC Form 159-W Interstate Telecommunications Service Provider Worksheet

Interstate Telephone Service Provider Worksheet, FCC Form 159-W

0949_FCC Form 159w_012607

Interstate Telephone Service Provider Worksheet, FCC Form 159-W

OMB: 3060-0949

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Federal Communications Commission

Approved by OMB
3060-0949

Interstate Telephone Service Provider (ITSP) Regulatory Fee Bill

This bill is a combined 2006 FCC Regulatory Fee Worksheet Form 159-W and Remittance Advice Form 159. It has been
completed using information from your previously submitted FCC Form 499-A. Add information requested below and remit this
page with your payment. If any information shown on this page is incorrect, show corrections on this page. If you correct any
revenue amounts, include a copy of your latest filed FCC Form 499-A. If you also must make revisions to your FCC Form 499-A,
include the revised form with your payment and also file that form with the FCC's Data Collection Agent. See 499-A Instructions.
Block (23A) - FCC Call Sign/Other ID

Attention:

[Filer 499 ID] - [Fee Year]

Filing must be received by September 19, 2006.
See Public Notice. http://www.fcc.gov/fees/regfees.html

8nnnnn-2006
Block (24A) - Payment Type Code

BILL FOR
9999

0672
Block (25A) - Quantity

Legal Name
address
City, State

[Your regulatory fee base]

ZIP

$0.00
Block (27A) - Total Fee
$0.00
Block (28A) - FCC CODE 1

If the revenue information on this page is correct, you may sign below and submit this page
in lieu of a separate Remittance Advice Form 159 and Form 159-W Regulatory Fee Worksheet
Block (21) - Applicant FRN
Please Verify / Supply
FCC Use Only -- Bill Number
' 0014-nnnn-nn
<~~~~ FRN
06RE00nnnn

$0.00
Block (29A) - FCC CODE 2

Note: if all FCC regulatory fees that you owe total less than $10, you are not required to file or remit payment.

[excluded interstate end-user revenues]

[Interstate & Intl. end-user revenues]

FCC Form 159-W Regulatory Fee Worksheet (based on your FCC Form 499-A filing)

$0.00

Calendar year 2005 revenue information shown in whole dollars
1
2
3
4
5
6
7
8
9
10
11

12
13
14
15
16

Service provided by U.S. carriers that both originates and terminates in foreign points. FCC Form 499-A Line 412 (e)

Interstate end-user revenues from all telecommunications services. FCC Form 499-A Line 420 (d)
International end-user revenues from all telecommunications services except
international-to-international. FCC Form 499-A Line 420 (e)
Total interstate and international end-user revenues (Sum of Lines 1, 2 and 3)
Note: also enter this number on Block (28A) - "FCC Code 1."
End-user interstate mobile service monthly and activation charges. FCC Form 499-A Line 409 (d)
End-user international mobile service monthly and activation charges. FCC Form 499-A Line 409 (e)
End-user interstate mobile service message charges including roaming charges but excluding toll charges.
FCC Form 499-A Line 410 (d)
End-user international mobile service message charges including roaming charges but excluding toll charges.
FCC Form 499-A Line 410 (e)
End-user interstate satellite service. FCC Form 499-A Line 416 (d)
End-user international satellite service. FCC Form 499-A Line 416 (e)
Surcharges on mobile and satellite services identified as recovering universal service contributions and
included in Line 403 (d) or 403 (e) on your FCC Form 499-A. [Note: you may not include
surcharges applied to local or toll services, nor any surcharges identified as intrastate surcharges.]
Interstate and international revenues from resellers that do not contribute to USF. Form 499-A Line 511 (b)
Total excluded end-user revenues. (Sum Lines 5 through 12.) Note: also enter this number
on Block (29A) - "FCC Code 2".
Total subject revenues. (Line 4 minus Line 13) Note: also enter this number on Block (25A) - "Quantity".
Interstate telephone service provider fee factor
2006 Regulatory Fee (Line 14 times Line 15)* Note: also enter this number on Block (27A) - "Total Fee"

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
0.00264
$0.00

* You are exempt if you owe less than $10 for all FCC reg. fees. If the above figures are correct, you may certify and use this page in lieu of completed Forms 159 & 159-W.

Required for All Filers:

Block (11) - Payer FRN

Block (9) - Telephone #

Block (2) - Payer Name

I, _______________________________________ CERTIFY under penalty of perjury that the foregoing and supporting information is true and correct to the
(please print)

best of my knowledge, information and belief. (Signature) ___________________________________________________ (Date) _____/______/_2006_
Credit
***** The U.S. Treasury is limiting Credit Card payments to $99,999.99 or less. Any amounts over this limit will not be processed *****
Card |__| MasterCard |__| Visa |__| Discover |__| AmEx Credit Card #__________________________________ Expir. Date _________
Payers I hereby authorize the FCC to charge my credit card above for the services/authorizations herein described
Only

 (Signature) ___________________________________________ (Date) _____/______/_2006_

FCC CORES Help Desk (877) 480-3201, Select Option 4. For FCC Form 499 questions contact Data Collection Agent at 973-560-4460

Attention: Filing must be received by September 19, 2006. See Public Notice.

FCC FORM 159-W
July 2006


File Typeapplication/pdf
File TitleTEMP.WK4
AuthorJim.Lande
File Modified2007-01-16
File Created2007-01-16

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