Universal Service - Schools and Libraries Universal Service Program Reimbursement Forms

FCC Form 474

Approved by OMB 3060-0856
Estimated time per response: 1.5 hours
Universal Service for Schools and Libraries
Service Provider Invoice Form

Instructions for Completing the
Universal Service for Schools and Libraries
Service Provider Invoice Form
FCC NOTICE FOR INDIVIDUALS REQUIRED BY THE PRIVACY ACT AND THE PAPERWORK REDUCTION ACT
Part 54 of the Commission’s Rules authorizes the FCC to collect the information on this form. Failure to provide all
requested information will delay the processing of the application or result in the application being returned without action.
Information requested by this form will be available for public inspection. Your response is required to obtain the
requested authorization.
The public reporting for this collection of information is estimated to range from 1 to 2 hours per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the required data, and
completing and reviewing the collection of information. If you have any comments on this burden 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 Act Project (3060-0856), Washington, DC 20554. We will also accept your comments
regarding the Paperwork Reduction Act aspects of this collection via the Internet if you send them to [email protected].
PLEASE DO NOT SEND YOUR RESPONSE TO THIS FORM 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 OMB control number or if
we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0856.
THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31,
1974, 5 U.S.C. 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1,
1995, 44 U.S.C. SECTION 3507.

I. INTRODUCTION
The FCC Form 474, Service Provider Invoice Form, is to be completed and submitted by a service provider that has
provided discounted eligible services to eligible schools and libraries, in order to seek universal service support in the
amount of the discounts. The service provider must have provided the service and given a discounted bill to the applicant
prior to submitting the Form 474.

II. FILING REQUIREMENTS AND GENERAL INSTRUCTIONS
Who Must File?
The service provider that has provided discounted eligible services and discounted bills to eligible schools, school
districts, libraries, library consortia and consortia of multiple entities, pursuant to a Funding Commitment Decision Letter
(FCDL) issued by the Schools and Libraries Division (SLD) of the Universal Service Administrative Company (USAC),
must file this Form 474 to seek reimbursement for the cost of the discounts. The service provider must be the entity
whose Service Provider Identification Number (SPIN) is associated with a service or group of services in a Funding
Request Number (FRN) approved by USAC. An FRN is a service or group of services for which funding was requested in
a distinct Block 5 of the applicant’s FCC Form 471, Services Ordered and Certification Form. USAC will issue an FCDL
to each applicant who submitted the FCC Form 471, Services Ordered and Certification Form, and to each service
provider whose SPIN is identified on a Form 471 as the provider of the services for which discounts have been requested.
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The FCDL will identify the amount of discounts that have been approved for each FRN and the SPIN for the service
provider that is authorized to provide the discounted services. Throughout these Instructions, the service provider will be
referred to as “you.”
When to File?
The service provider may file the Service Provider Invoice Form seeking reimbursement of discounts provided pursuant to
an approved FRN upon the occurrence of all of the following conditions:
•
•
•
•
•

upon receipt of an acknowledgment from USAC that the billed entity applicant has filed a Form 486, Receipt of
Services Confirmation Form;
upon providing discounted, eligible services to an eligible school, school district, library, library consortium or
consortium of multiple entities on or after the effective date of the discounts as set forth in USAC’s acknowledgement
of receipt of Form 486;
after billing the Form 471 recipient of an FCDL for eligible services, showing the total prediscount amount, the
discounted portion and the applicant’s obligation to pay the undiscounted amount;
after the service provider completes and submits its Annual Service Provider Certification Form, FCC Form 473, to
USAC; and
no later than 120 days after the end of the pertinent funding year service delivery period. The delivery period for
recurring services is generally July 1 through June 30 of the following year; the period for non-recurring services is
generally from July 1 through September 30 of the following year. See USAC’s at www.usac.org/sl for specific
information about invoice due dates.

Service Provider Annual Certification Form
The FCC Form 473, Service Provider Annual Certification Form, is used by the service provider to confirm that the service
provider’s invoice forms are completed in compliance with FCC rules governing the schools and libraries universal service
support mechanism. The Form 473 must be completed and submitted by the service provider prior to the service
provider submitting its first invoice form to USAC. No invoices will be paid without a Form 473 filed for the pertinent
funding year. If you have not done so already, please be sure to complete and submit the Form 473.
Where to File?
The Form 474 may be submitted online, manually, or electronically.
To file online, service providers should check the USAC Web Site www.usac.org/sl under Required Forms. Scroll down
to the bottom of the page to Service Provider Forms and locate the Online Filing option for the Form 474.
For Forms 474 submitted on paper, the Form should be mailed to USAC at: SLD Form 474, P.O. Box 7026, Lawrence,
KS 66044-7026, or alternatively, for those service providers using express delivery services or U.S. Postal Service Return
Receipt, the following address should be used: SLD Forms ATTN: Form 474, 3833 Greenway Drive, Lawrence, KS
66046, telephone number 1-888-203-8100.
Service providers that prefer to submit their invoices electronically, which requires encryption, USAC should request
information about that process by sending an email using the “Submit a Question” feature on our website.
Note: DO NOT FILE THIS OR ANY OTHER UNIVERSAL SERVICE FORM WITH THE FEDERAL COMMUNICATIONS
COMMISSION.
Compliance.
Anyone filing false information is subject to penalties for false statements, including fine or forfeiture, under the
Communications Act, 47 U.S.C. §§ 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18
U.S.C. § 1001.
All of the information required in the Form 474 must be completed, in order for this form to be accepted by USAC for entry
into our data system. These instructions set forth the requirements for a valid entry. If you have any questions about
completing this form, please contact the SLD Client Service Bureau at 888-203-8100, or visit the USAC website at
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www.usac.org/sl , before submitting the form. If it is not properly completed, the form may be rejected and returned to
you.
Where to Get More Information?
You may call the SLD Client Service Bureau at 1-888-203-8100, send an email using the “Submit a Question” feature on
our website or a fax to 1-888-276-8736 for more information on how to complete this or other universal service forms.
Information is also available on the USAC website at www.usac.org/sl.

III. SPECIFIC INSTRUCTIONS
Type or clearly print in the spaces provided. Please attach additional pages only when necessary.
Item (1) - Service Provider Name. Provide your name as indicated on the corresponding Form 471 Funding
Commitment Decision Letter.
Item (2) - Service Provider Identification Number (SPIN). Provide the number assigned to your company for delivering
the services included within the Funding Request Numbers (FRNs) for which you are submitting this Service Provider
Invoice Form. An FRN is a distinct service or group of services included in a Block 5 of the applicant’s Form 471.
Item (3) - Contact Name. Provide the name of the person who should be contacted with questions about this form. The
contact person must be able to answer questions in a timely manner regarding the information included in this form and
the eligible services that have been or are being provided.
Item (4) - Contact Telephone Number, Fax Number and Email Address. Provide the telephone number with area
code for contacting the person identified in Item (3). You may also include an extension of up to four (4) digits, for a total
of 14 digits. Provide the fax number with area code and the email address for contacting the person identified in Item (3).
Item (5) - Invoice Number. Please assign a unique number to identify this Service Provider Invoice Form for your own
records. This number could be generated by your usual billing system or created specifically for this purpose. We will
refer to this number to identify this particular invoice should we need to contact you concerning this Invoice Form.
Item (6) - Invoice Date to USAC. Provide the date that the service provider completed and mailed or electronically
transmitted this form to USAC. Please note that this date is expected to be later than the date that the service provider
submitted the bill to the school or library pursuant to an FRN for the eligible services.
Item (7) - Total Invoice Amount. Provide the total amount associated with this invoice. This amount should be the
sum of the entries in Column (14).
Columns (8) through (14)
The information requested in the following columns should be completed for the eligible services in each FRN for which
the service provider with the assigned SPIN set forth in Item (2) has delivered services on or after the effective date of
discounts, consistent with the FCDL provided by USAC and for which the service provider has billed the applicant.
Column (8) - FCC Form 471 Application Number. This number is assigned by USAC to the Form 471 that the
applicant submitted. This number should be obtained from the FCDL issued by USAC.
Column (9) - Funding Request Number (FRN). This number is assigned by USAC to each Block 5 of the Form 471
application containing a request for funding of discounts for a service or group of services. Each Funding Request
Number (FRN) is set forth on the FCDL issued by USAC.
Column (10) - Bill Frequency. Provide the time interval that applies to the billing relationship between the Form 471
applicant and the service provider. Select the appropriate item from the drop down box for online filing or one of the
following choices: Monthly, Quarterly, Annually, One-Time, or Other.
Column (11) - Customer Billed Date. The Customer Billed Date (mmyyyy) is the month and year of the bill submitted
by the service provider to its customer and upon which this Service Provider Invoice Form is based. This column should
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be completed for invoices that are provided to customers for eligible services billed as part of a recurring, regular billing
cycle; that is, for bills provided to customers on either a monthly or quarterly basis. While the FRN may include both
recurring and non-recurring charges, provided the billing relationship is based on the service provider’s periodic
submission of invoices to the customer, these should be separated into two separate lines on the Invoice Form.
Column (12) - Shipping Date to Customer or Last Day of Work Performed. This column should be completed for a
bill/invoice issued to a customer:
• for eligible services and/or products delivered on a one-time non-recurring basis, AND
• when the customer/service provider billing relationship is based on the service provider’s submission of the bill/invoice
for all charges due from the customer for eligible services/products, OR
• the customer/service provider billing relationship is based upon the last day of work performed.
Please note that only Column 11 OR Column 12 should be completed for each FRN. Please do NOT complete
BOTH Columns 11 and 12 for the same FRN.
Column (13) - Total (Undiscounted) Amount for Service per FRN. This column represents the total undiscounted
monthly and one-time charges for all services on the individual invoice or bill issued to the customer per FRN based on
the FCDL. This column represents the total price for service before any eligible discount is applied. The total
undiscounted amount may include all reasonable associated charges, such as federal and state taxes, that are incurred
by the customer in obtaining services.
Column (14) - Discount Amount Billed to USAC. The discount amount represents the total amount of funds billed to
USAC, and for which the service provider requests reimbursement on this invoice. This is the amount of support that,
when combined with the school or library payment to the service provider, equals the total undiscounted amount in
Column (13).
Reminder: You must complete and submit a Service Provider Annual Certification Form, FCC Form 473, to USAC in
order for any invoice form to be processed promptly. Please be sure to complete and submit the Form 473 before you
submit this Form 474 to USAC.

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