Competitive Carrier Line Count Report and Self-Certification as a Rural Carrier, FCC Forms 525 and 481

Competitive Carrier Line Count Report and Self-Certification as a Rural Carrier, FCC Forms 525 and 481

0986_HCRateFloorTemplate_121611.xls

Competitive Carrier Line Count Report and Self-Certification as a Rural Carrier, FCC Forms 525 and 481

OMB: 3060-0986

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Overview

RATE FLOOR REPORT
CERTIFICATION-REPORTING CARRIER
CERTIFICATION-AGENT


Sheet 1: RATE FLOOR REPORT

RATE FLOOR DATA COLLECTION - OMB Control Number 3060-0986
Block 1 - Contact Information
ROW # DATA ELEMENT FORMAT OF REQUESTED DATA RESPONSE
1 Carrier Study Area Code 6 numeric digits
2 Carrier Study Area Name alpha characters
3 Service Provider Identification Number 9 numeric digits
4 Residential Local Service Charge Effective Date mm/dd/yyyy
5 Contact Name alpha characters
6 Contact Telephone Number (include area code) 9 numeric digits
7 Sheet number numeric digit(s)
8 Total Number of Sheets numeric digit(s)
Block 2 - Residential Local Service Rates, Fees, and Line Counts

Column 1
Residential Local Service Charge
Column 2
State Subscriber Line Charge
Column 3
State Universal Service Fee
Column 4
Mandatory Extended Area Service Charge
Column 5
Loops

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Sheet 2: CERTIFICATION-REPORTING CARRIER

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING RATE FLOOR DATA ON ITS OWN BEHALF:


























































Certification of Officer as to the Accuracy of the Data Reported for the Rate Floor Data





























































Name of Reporting Carrier
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. _ _ _ _ _
Study Area Code of Reporting Carrier

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





Sheet 3: CERTIFICATION-AGENT

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING RATE FLOOR DATA ON THE CARRIER'S BEHALF:













































Certification of Officer or Employee to Authorize an Agent to File Rate Floor Data on Behalf of Reporting Carrier

















Name of Authorized Agent
Name of Reporting Carrier
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. _ _ _ _ _
Study Area Code of Reporting Carrier

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



TO BE COMPLETED BY THE AUTHORIZED AGENT:













































Certification of Agent Authorized to File Rate Floor Data Reported on Behalf of Reporting Carrier































Name of Reporting Carrier
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: ( _ _ _ ) _ _ _ - _ _ _ _, ext. _ _ _ _ _
Study Area Code of Reporting Carrier

Filing Due Date for this form (mmddyyyy)



File Typeapplication/vnd.ms-excel
File TitleFCC Form 507 (Horizontal)
SubjectOTHR
Last Modified Byjudith
File Modified2011-12-16
File Created2002-05-06

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