Form FCC Form 525 FCC Form 525 Competitive Carriers High Cost Data Submission

FCC Form 525
High Cost Support Mechanism
Competitive Carrier Line Count Report

FCC Form 525
OMB Control No. 3060-0986
June 2009

COMPETITIVE CARRIERS HIGH COST DATA SUBMISSION
(1) Quarterly Submission Date:
Do Not Write in this Area:
For Administrator's Use Only

(2) USAC Service Provider Identification Number (SPIN):
(3) Company Study Area Code: (First time filers leave blank and a Study Area Code will be assigned)

(4) Study Area Name:
(5) Company Legal Name:
(6) Filer 499 ID:
Check Box if this is a new address/contact from a previous data submission:
(7) Mailing Address:
(8) Contact Name:

(9) Title:

(10) Telephone Number:
(11) E-mail Address:

(12) Mechanism for which you are requesting support:

(13) Lines Reported as of:

(14) Type of Filing
Original
Revision

(15) Worksheet to Complete

High Cost Loop Support (HCL)

Complete HCL and LSS

Local Switching Support (LSS)

Complete HCL and LSS

Interstate Common Line Support (ICLS)

Complete ICLS Worksheet

High Cost Model Support (HCM)

Complete HCM Worksheet

Interstate Access Support (IAS)

Complete IAS Worksheet

Competitive Carrier Information

Page 1

FCC Form 525
High Cost Support Mechanism
Competitive Carrier Line Count Report

FCC Form 525
OMB Control No. 3060-0986
June 2009

HIGH COST LOOP (HCL) AND LOCAL SWITCHING SUPPORT (LSS) LINE COUNT WORKSHEET
(2) USAC Service Provider Identification Number (SPIN):

0

(3) Company Study Area Code:

0

(4) Study Area Name:

0

Do Not Write in this Area:
For Administrator's Use
Only

(13) Lines Reported as of:
(14) Type of Filing:

Line Count Data for Path 1, 2 & 3 Carriers
Where carrier reports both UNEs and facilities based lines in the same SAC or disaggregation zone, carrier shall list UNEs in a separate
row. Complete one row for each disaggregation zone.
(16) Incumbent Carrier Name
(20) Disaggregation Zone
(17) Incumbent (18) ETC
(19) Path
Name
Carrier SAC
Designation
Designation

Use an additional sheet if necessary.

HCL & LSS Line Count Worksheet

(21) Wire Center CLLI Code

(22) Total Number of
Lines in Service

(23) Were any lines provided through UNEs?
If yes, please fill out the UNE Agreement
Information.

FCC Form 525
High Cost Support Mechanism
Competitive Carrier Line Count Report

FCC Form 525
OMB Control No. 3060-0986
June 2009

INTERSTATE COMMON LINE SUPPORT (ICLS) LINE COUNT WORKSHEET
(2) USAC Service Provider Identification Number (SPIN):

0

(3) Company Study Area Code:

0

(4) Study Area Name:

0

Do Not Write in this Area:
For Administrator's Use

(13) Lines Reported as of:
(14) Type of Filing:

Line Count Data for Path 1, 2 & 3 Carriers
Complete one row for each disaggregation zone.
(24) Incumbent Carrier Name

(25) Incumbent
Carrier SAC

(26) ETC
Designation

(27) Path Designation

(28) Disaggregation
Zone Name

(29) Wire Center CLLI
Code

(30) Residence & Single
Line Business

(31) Multi-line (32) Total Number of
Business
Lines in Service

Use an additional sheet if necessary.

ICLS Line Count Worksheet

Page 3

FCC Form 525
High Cost Support Mechanism
Competitive Carrier Line Count Report

FCC Form 525
OMB Control No. 3060-0986
June 2009

HIGH COST MODEL (HCM) LINE COUNT WORKSHEET

(2) USAC Service Provider Identification Number (SPI

0

(3) Company Study Area Code:

0

(4) Study Area Name:

0

Do Not Write in this Area:
For Administrator's Use Only

(13) Lines Reported as of:
(14) Type of Filing:

Complete one row for each Wire Center.

(33) Incumbent Carrier Name

Use an additional sheet if necessary.

HCM Line Count Worksheet

(34)
Incumbent
Carrier SAC

(35) ETC
Designation

(36) Wire Center CLLI Code

(37) Wire Center Name

(38) Total Lines

FCC Form 525
High Cost Support Mechanism
Competitive Carrier Line Count Report

FCC Form 525
OMB Control No. 3060-0986
June 2009

INTERSTATE ACCESS SUPPORT (IAS) LINE COUNT WORKSHEET

(2) USAC Service Provider Identification Number
(SPIN
(3) Company Study Area Code:

0

(4) Study Area Name:

0

0

(13) Lines Reported as of:

#REF!

(14) Type of Filing:

#REF!

Complete one row for each Incumbent Carrier Area Served.
(39) Incumbent Carrier Name

Do Not Write in this Area:
For Administrator's Use
Only

(40)
Incumbent
Carrier SAC

(41) ETC
Designation

Zone 1
(42) Residence & (43) Multi-line
Single Line
Business
Business

Zone 2
(44) Residence & (45) Multi-line
Single Line
Business
Business

Number of Lines
Zone 3
(46) Residence & (47) Multi-line
Single Line
Business
Business

Zone 4
(48) Residence & (49) Multi-line
Single Line
Business
Business

(50) Total Lines

Use an additional sheet if necessary.

IAS Line Count Worksheet

Page 5

FCC Form 525
High Cost Support Mechanism
Competitive Carrier Line Count Report

FCC Form 525
OMB Control No. 3060-0986
June 2009

UNBUNDLED NETWORK ELEMENTS REPORTING
(2) USAC Service Provider Identification Number (SPIN):

0

(3) Company Study Area Code:

0

(4) Study Area Name:

0

Do Not Write in this Area:
For Administrator's Use
Only

Complete one worksheet for each study area of a Path 1 rural incumbent carrier in which the competitive carrier is reporting lines and uses unbundled network elements ("UNEs") to serve the reported lines. The competitive carrier must separately identify the number of UNE loops; UNE price per loop; any port and vertical services costs
included in the UNE loop price; number of loops receiving UNE switching service, the UNE switching price per minute and number of switching minutes.

(51) Incumbent Carrier Name:
(52) Incumbent Carrier Study Area Code:
Please provide the following information for Path 1 Rural Incumbent Carrier Study Areas:
(53) UNE Zone

Loops w/o Port Cost
(54) No. of Loops

(55) Price per loop

Loops w/ Ports
(56) No. of ports

(57) Price/port

Vertical Services
(58) No. of loops w/ Vertical
Services

(59) Price for vertical
services on each loop

Switching
(60) No. of loops with switching

(61) No. of switching minutes

(62) Price/minute

Zone 1
Zone 2
Zone 3
Zone 4
Zone 5
Complete one worksheet for each study area of a Path 2 or Path 3 rural incumbent carrier in which the competitive carrier is reporting lines and uses unbundled network elements ("UNEs") to serve the reported lines. For each incumbent study area, list the name of each disaggregation zone
. If the disaggregation zone includes more than one
UNE zone, please report the lines in each UNE zone per disaggregation zone on a separate row. The competitive carrier must separately identify the number of UNE loops; UNE price per loop; any port and vertical services costs included in the UNE loop price; number of loops receiving UNE switching service, the UNE switching price per
minute and number of switching minutes.

Please provide the following information for Path 2 and Path 3 rural incumbent carrier study areas:
(63) UNE Zone Name
(64) Disaggregation Zone Name

(65) UNE type

(66) Quantity

(67) Price

(68) Minutes

Loops without port costs
Ports
No. of loops w/ Vertical Services
No. of loops w/ switching
Loops without port costs
Ports
No. of loops w/ Vertical Services
No. of loops w/ switching
Loops without port costs
Ports
No. of loops w/ Vertical Services
No. of loops w/ switching
Loops without port costs
Ports
No. of loops w/ Vertical Services
No. of loops w/ switching
Loops without port costs
Ports
No. of loops w/ Vertical Services
No. of loops w/ switching
UNE Agreement Information

Page 6

FCC Form 525
High Cost Mechanism
Competitive Carrier Line Count Report

FCC Form 525
OMB Control No. 3060-0986
June 2009

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING FCC FORM 525 ON ITS OWN BEHALF:

Certification of Officer or Employee as to the Accuracy of the Data Reported in FCC Form 525, Line Count Report for Competitive Carriers, on
Behalf of Reporting Carrier

I certify that I am an officer or employee of the reporting carrier; my responsibilities include ensuring the accuracy of the actual line count data reported on
FCC Form 525; and, to the best of my knowledge, the information reported on this form is accurate.

Name of Reporting Carrier:

0

Service Provider Identification Number:

0

Signature of authorized officer or employee:

Date:

Printed name of authorized officer or employee:
Title or position of authorized officer or employee:
Telephone number of authorized officer or employee: (
Study Area Code of Reporting CETC

ext.
0

Filing Due Date for this form
(mm/dd/yyyy)

Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act of 1934, 47 U.S.C. §§ 502, 503(b), or fine or
imprisonment under Title 18 of the United States Code, 18 U.S.C. § 1001.

Certification-Reporting Carrier

Page 7

FCC Form 525
High Cost Support Mechanism
Competitive Carrier Line Count Report

FCC Form 525
OMB Control No. 3060-0986
June 2009

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING FCC FORM 525 ON THE CARRIER'S BEHALF:

Certification of Officer or Employee to Authorize an Agent to File FCC Form 525, Line Count Report for Competitive Carriers, on Behalf o
Reporting Carrier

I certify that (Name of Agent) ________________________________________________________ is authorized to submit the information reported on FCC
Form 525 on behalf of the reporting carrier. I also certify that I am an officer or employee of the reporting carrier; my responsibilities include ensuring the
accuracy of the actual line count data provided to the authorized agent; and, to the best of my knowledge, the actual line count data provided to the
authorized agent is accurate.

Name of Authorized Agent:

Name of Reporting Carrier:

0

Service Provider Identification Number:

0

Signature of authorized officer or employee:

Date:

Printed name of authorized officer or employee:

Title or position of authorized officer or employee:

Telephone number of authorized officer or employee: (
)
ext.
Filing Due Date for this form
(mm/dd/yyyy)
Study Area Code of Reporting CETC 0
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act of 1934, 47 U.S.C.
§§ 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. § 1001.

TO BE COMPLETED BY THE AUTHORIZED AGENT:

Certification of Agent Authorized to File FCC Form 525, Line Count Report for Competitive Carriers, on Behalf of Reporting Carrier
I, as agent for the reporting carrier, certify that I am authorized to submit the information reported on FCC Form 525 on behalf of the reporting carrier; I have
provided the line count data reported herein based on actual line count data provided by the reporting carrier; and, to the best of my knowledge, the information
reported herein is accurate. I also certify that I will provide copies of the line count filing to the reporting carrier within 15 days.

Name of Reporting Carrier:

0

Name of Authorized Agent:

Signature of authorized agent or employee of agent:

Date

Printed name of authorized agent or employee of agent:

Title or position of authorized agent or employee of agent:

Telephone number of authorized agent: (
Study Area Code of Reporting CETC

0

ext.
Filing Due Date for this form
(mm/dd/yyyy)

Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act of 1934, 47 U.S.C. §§ 502, 503(b), or fine or
imprisonment under Title 18 of the United States Code, 18 U.S.C. § 1001.

Certification-Agent

Page 8

FCC Form 525
High Cost Support Mechanism
Competitive Carrier Line Count Form

FCC Form 525
OMB Control No. 3060-0986
June 2009

NOTICE: Sections 54.307(b) and 54.802(a) of the Federal Communications Commission's rules requires all competitive eligible telecommunications carriers to provide line
count information to USAC, the universal service Administrator, in order to be eligible to receive support. Pursuant to Sections 54.307(c) and 54.802(a), this information
must be submitted by support mechanism on a quarterly basis in accordance with the incumbent carrier's line count reporting schedule. 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. The data in the form will be used to calculate the
amount of support, if any, that each reporting carrier is eligible to receive from the High Cost support mechanisms.
We have estimated that each response to this collection of information will take, on average, 5 hours. Our 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, Washington, D.C. 20554, Paperwork
Reduction Project (3060-0986). We will accept your comments via the Internet if you send them to [email protected]. 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 30600986.
The Commission is authorized under the Communications Act of 1934, as amended, to collect the information we request in this form. We will use the information that you
provide to determine High Cost support amounts for competitive eligible telecommunications carriers. If we believe 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 support mechanisms, 47.C.F.R. §§
54.307 and 54.802.
The foregoing Notice is required by the Paperwork Reduction Act of 1995, P.L. No. 104-13, 44 U.S.C. § 3501, et seq.

Notice

Page 9