Universal Service - Schools and Libraries Universal Service Program - FCC Form 470, State, Local, or Tribal Government

OMB 3060-0806
FCC Form 470

Approval by OMB
3060-0806
Schools and Libraries Universal Service
Description of Services Requested and Certification Form
Estimated Average Burden Hours Per Response: 3 hours
Instructions for Completing the
Schools and Libraries Universal Service
Description of Services Requested and Certification Form (FCC Form 470)

CONTENTS
I. PURPOSE OF THE FORM …………………………………………………………………………...1
II. GENERAL INSTRUCTIONS ................................................................................................................ 1
A. Who Must File ................................................................................................................................. 1
B. When, Where, and How Many FCC Forms 470 to File .................................................................. 2
C. Assistance in Completing This Form............................................................................................... 3
III. SPECIFIC INSTRUCTIONS ................................................................................................................. 3
A. Beginning of Form ........................................................................................................................... 4
B. Block 1: Applicant Address and Information .................................................................................. 4
C. Block 2: Summary Description of Needs or Services Requested .................................................... 5
D. Block 4: Billed Entities .................................................................................................................... 7
E. Block 5: Certifications and Signature .............................................................................................. 8
I.

PURPOSE OF THE FORM

To start the process of seeking funding for eligible services under the E-rate program (more formally known as the
schools and libraries universal service support program), applicants must initiate the required competitive bidding
process by filing the FCC Form 470 online with USAC. Starting in funding year 2015, the FCC Form 470 must be
completed online. USAC will post this FCC Form 470 on the USAC website. Unless E-rate rules exempt an
applicant from competitive bidding, an applicant must wait 28 days after the FCC Form 470 is posted on the USAC
website, www.usac.org/sl, or 28 days after the RFP is made publicly available, whichever is later, to enter into
contracts for new services or to select service providers for tariffed or month-to-month services. USAC will notify
the applicant of the date that the applicant’s request is posted and the date on which the 28-day waiting period ends
based on the date that the FCC Form 470 was posted to the website. Complete program information – including more
information on the competitive bidding requirements – is available at the USAC website at www.usac.org/sl. You
may also contact the USAC Client Service Bureau (CSB) at 1-888-203-8100.
II.

GENERAL INSTRUCTIONS
A.

Who Must File

Schools and libraries requesting universal service discounts must seek competitive bids using FCC Form 470 as
required by Commission rules. The entity that will negotiate with potential service providers must complete the FCC
Form 470. The FCC Form 470 cannot be completed by a service provider who will participate in the competitive
process as a bidder.
No FCC Form 470 is required for:
•

Business-class Internet access services. Starting with funding year 2015, certain commercially available
business-class Internet access services are exempt from the requirement to post an FCC Form 470. Please see the
USAC website for more information.

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•

Preferred master contracts. Starting with funding year 2015, contracts designated by the Wireline Competition
Bureau of the FCC as preferred master contracts may be exempt from the requirement to post an FCC Form 470.
Please see the USAC website for more information.

Eligibility of schools
For purposes of the universal service support mechanism, schools must meet the statutory definition of elementary
and secondary schools found in the No Child Left Behind Act of 2001, 20 U.S.C. §§ 7801(18) and (38). An
elementary school is a non-profit institutional day or residential school, including a public elementary charter school,
that provides elementary education, as determined under state law. 47 C.F.R. § 54.500; 20 U.S.C. § 7801(18). A
secondary school is a non-profit institutional day or residential school, including a public secondary charter school,
that provides secondary education, as determined under state law, except that such term does not include any
education beyond grade 12. 47 C.F.R. § 54.500; 20 U.S.C. § 7801(38). Schools operating as for-profit businesses or
who have endowments exceeding $50 million are not eligible.
Eligibility of libraries
Libraries must meet the statutory definition of library or library consortium found in the Library Services and
Technology Act, 20 U.S.C. § 9121, et seq., (1996) (LSTA) and must be eligible for assistance from a state library
administrative agency under that Act. A library includes: "(1) a public library; (2) a public elementary school or
secondary school library; (3) an academic library; (4) a research library, which for the purposes of this definition
means a library that: (i) makes publicly available library services and material suitable for scholarly research and not
otherwise available to the public; and (ii) is not an integral part of an institution of higher education; and (5) a private
library, but only if the state in which such private library is located determines that the library should be considered a
library for purposes of this definition." 47 C.F.R. § 54.500. A library's eligibility for universal service funding also
depends on its funding as an independent entity. Only libraries whose budgets are completely separate from any
schools’ (including, but not limited to, elementary and secondary schools, colleges and universities) shall be
eligible to receive discounted services under the universal service support mechanism. 47 C.F.R. §
54.501(c)(2). For example, an elementary school library would only be eligible to receive discounted services if its
budget were completely separate from the elementary school. If its budget were not completely separate from the
elementary school, the elementary school library would not be eligible for support independent from the school with
which it is associated. Libraries operating as for-profit businesses shall not be eligible for discounts.
Eligibility of consortia and library consortia
A consortium is “any local, statewide, regional, or interstate cooperative association of schools and/or libraries
eligible for E-rate support that seeks competitive bids for eligible services or funding for eligible services on behalf
of some or all of its members.” 47 C.F.R. § 54.500(c).
A library consortium is “any local, statewide, regional, or interstate cooperative association of libraries that provides
for the systematic and effective coordination of the resources of school, public, academic, and special libraries and
information centers, for improving services to the clientele of such libraries.” 47 C.F.R. § 54.500(e).
B.

When, Where, and How Many FCC Forms 470 to File

When:
The FCC Form 470 for the upcoming funding year is generally available on the USAC website one year before the
start of the funding year on July 1. Notice will be posted each year on the USAC website when USAC will begin
accepting FCC Forms 470 for posting for the upcoming funding year. Once the FCC Form 470 is available online, it
can be filed and posted. Applicants should check the USAC website, www.usac.org/sl, or contact USAC Client
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Service Bureau (CSB) at 1-888-203-8100 to obtain information on when the FCC Form 470 will be available.
You are required to file FCC Form 470 in the current application period only if you are applying for discounts for one
of the following types of services:
•
•

Tariffed or month-to-month services for which you do not have a signed, written contract.
Services for which a new written contract is sought for the funding year in Item 2 (unless the contract meets the
requirements for an exemption contained in FCC rules).

You can file your FCC Form 470 to begin your procurement process, as long as it is at least 28 days before you select
your service provider and file FCC Form 471 for those services. Services covered by a qualified existing contract
for all or part of the funding year, including multi-year contracts signed pursuant to the posting of an FCC Form 470
in a previous funding year, do not require the filing of an FCC Form 470, because you are not seeking bids for these
services. A qualified existing contract is a signed, written contract executed pursuant to the posting of an FCC Form
470 in a previous funding year.
Where:
The FCC Form 470 must be filed online at the USAC website, www.usac.org/sl.
How many:
You may file one FCC Form 470 for all of the services for which you are required to file an FCC Form 470, or you
may file separate FCC Forms 470 for each type of service. Also, an individual school or library may be covered by
more than one FCC Form 470 filed by different applicants for different services.
After your FCC Form 470 is posted:
Once you file your FCC Form 470, it is posted to the USAC website for competitive bidding. Your form must be
posted for at least 28 days on the USAC website before you can select a service provider, sign a contract or enter into
an agreement for services, or sign or submit an FCC Form 471. After you sign a contract or select a service provider
– and after the FCC Form 471 application filing window has opened – you (or the billed entities you represent) can
initiate the next step in the application process, the filing of FCC Form 471. Upon processing or posting of the FCC
Form 470, the USAC will notify you of the earliest date upon which you may sign a contract or select a service
provider for new services or file FCC Form 471. This date will be referred to as the “Allowable Vendor
Selection/Contract Date.”
C.

Assistance in Completing This Form

There are several resources to guide you in completing this form. When you enter information on the USAC website,
prompts will assist you. You are also urged to consult the Reference Area of the USAC website for additional
program guidance that may be useful in completing this form: http://www.usac.org/sl/tools/reference-area.aspx. You
may also contact the CSB by e-mail using the “Submit a Question” link on the USAC website, by fax at 1-888-2768736, or by phone at 1-888-203-8100.
III.

SPECIFIC INSTRUCTIONS

You should complete, submit, and certify this form online at www.usac.org/sl.
Throughout this form, "you" refers to “the applicant” – a school or library, or an entity filing on behalf of schools and
libraries. The FCC Form 470 cannot be completed by a service provider who will participate in the competitive
process as a bidder.
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A.

Beginning of Form

Applicant’s Form Identifier – If you are filing more than one FCC Form 470, assign a unique number or letter of
your own devising to facilitate communication with us about this particular FCC Form 470. This Applicant’s Form
Identifier can be very simple; for example, if you are filing three FCC Forms 470, you might label them “A,” “B,”
and “C.” The Applicant’s Form Identifier can also be descriptive, such as “Internet.” Choose identifiers that suit your
own record-keeping needs.
FCC Form 470 Application Number – USAC will assign and insert your FCC Form 470 Application Number.
B.

Block 1: Applicant Address and Information

Block 1 of FCC Form 470 asks you for your address and basic information.
Item 1 – Provide the name of the applicant. You may be an individual school, a school district, a library
(outlet/branch, system) or a consortium of those entities. You may also be a city, a state, or an entity created solely to
participate in this universal service discount mechanism.
Item 2 – Funding years begin on July 1 and end on June 30. For example, funding year 2015 runs from July 1, 2015
to June 30, 2016. Provide the funding year for which you are applying for funds by filling in the appropriate year in
the blank provided (e.g., 2015).
Item 3 – Your Entity Number is a unique number assigned to your organization or institution as a means of
identifying you every time you file an application or otherwise communicate with us. If you have applied for
universal service funds in previous years, or have been identified in an application filed on your behalf, you have
already been assigned this number. If you do not have a record of your Entity Number, or if you believe you have
never been assigned such a number, please contact CSB at 1-888-203-8100. (See also “Assistance in Completing this
Form” above.)
Items 4a-4c – Provide your full mailing address, whether a street address, Post Office Box number, or route number.
In addition, please provide your telephone number (with area code and extension), and fax number (including area
code).
Item 5a – Check the one box that most accurately describes the eligible entities that will receive the services you are
seeking in this FCC Form 470. An entity is an eligible entity if it meets the eligibility criteria for obtaining discounts
described in Section II.A. above. If you are filing as an individual school, you should check the first box. If you are
filing as a school district or local education agency (LEA), you should check the second box. If you are filing as a
library (outlet/branch, system, or library consortium as defined under LSTA), you should check the third box. If you
are filing as a consortium, you should check the fourth box. You may be a non-statewide or regional consortium, a
consortium of schools, libraries or some combination of the above which may or may not include ineligible entities.
Check the fifth box if yours is a statewide application representing ALL entities of a particular type in your state. If
you check the fifth box, you must also check one or more of the three choices provided in this item – all public
schools/districts in the state, all non-public schools in the state, and/or all libraries in the state – and indicate the twoletter state code. This will indicate to potential service providers the complete breadth of your service needs. Please
note that if your application represents SOME but not ALL of any of these three types of entities, you should NOT
check the statewide application box.
Item 5b – Check all boxes that apply to you or any of the entities that will receive services under this form.
Item 5c – Specify the number of eligible entities that your application represents. For example, you would:
• Enter “1” if you are an individual school or a single site library.
• Enter “4” if you are a school district with an elementary school, a junior/senior high school, an administrative
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•
•

building, and a non-instructional facility such as a school bus barn.
Enter “7” if you are a library system with a main branch, four smaller branches, a bookmobile, and a library
technology center.
Enter “10” if you are a consortium with 10 individual member entities.

Item 6a – Provide the name of the person who should be contacted with questions about this application. This
person should be able to answer questions regarding the information included on this form and the services you
request, including how to obtain a copy of your RFP, if you have prepared one.
Items 6b-6e – Provide the contact person’s mailing address. USAC will use this address to mail correspondence
about this form. If the contact person’s address information is the same as Item 4 above, check the appropriate box
instead. Also provide the contact person’s phone number, fax number and e-mail address. You MUST indicate your
preferred mode of contact (telephone, fax, or e-mail) by checking the appropriate box.
Item 7 – If a consultant is assisting you with your application, provide the consultant’s name, employer, street
address, telephone number, fax, and e-mail address. Also, provide the Consultant Registration Number. A consultant
is any non-employee of the entity applying for funding that assists in filling out the application materials for a fee.
“Non-employee” includes contractors or others who are employed by the entity on a contract or short-term basis who
does not receive a W-2 application from the entity filling out the application. If the consultant does not have a
Consultant Registration Number, the consultant can contact CSB at 1-888-203-8100 to obtain one. (See “Assistance
in Completing this Form” above.)
C.

Block 2: Summary Description of Needs or Services Requested

Block 2 of FCC Form 470 asks you to describe the services you desire.
Items 8, 10, and 11 – One or more of Items 8, 10, or 11 must be completed to provide potential bidders with
particular information about the services you are seeking. For more information on eligible services, please refer to
the Eligible Services List on the USAC website at http://www.usac.org/sl/applicants/beforeyoubegin/eligibleservices-list.aspx or contact CSB at 1-888-203-8100. Once you check the relevant category of service box(es) in
Items 8, 10, and/or 11, you must check either box “a” or “b” under the selected item and complete the item. You
cannot seek discounts on services in a category of service on the FCC Form 471 if you have not competitively bid
those services on the FCC Form 470 or unless you are exempt from filing an FCC Form 470.
The specific data requested in Items 8, 10, and 11 are sought to provide potential service providers with information
so that they may contact you if necessary for detailed information on your specific requirements. This requirement
is not intended to restrict your ability to enter into a contract for new services or select a service provider for
tariffed or month-to-month services for whatever technologies best meet your educational purposes as
authorized by FCC rules and the Telecommunications Act of 1996. It is important that you complete all
categories that are relevant to your requested services, so that USAC can confirm that you have met the competitive
bidding requirement before signing any contracts for newly contracted services or selecting a service provider for
tariffed or month-to-month services for which discounts are requested on FCC Form 471.
Item 8 – Category One: Internet Access and/or Telecommunications
Category One includes the telecommunications services, telecommunications, and Internet access services for which
E-rate applicants may seek discounts. This category consists of the services that provide broadband to eligible
locations including data links that connect multiple points, services used to connect eligible locations to the Internet,
and services that provide basic conduit access to the Internet. Maintenance and technical support appropriate to
maintain reliable operation are eligible for support when provided as a component of these services. For more
information, see the Eligible Services List on the USAC website at
http://www.usac.org/sl/applicants/beforeyoubegin/eligible-services-list.aspx.
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Item 8a – Check this box if you have released or intend to release an RFP that will provide potential bidders with
specific information about the particular Category One services you are seeking, and what quantity and/or capacity
you seek. For example, you might have an RFP for voice services that specifies “local and long distance voice
services sought for 20 existing phone lines, plus 10 new additional lines.” Or you might have an RFP for Internet
Access that specifies “high-speed direct access to the Internet sought for 10 public Internet stations in one library
facility.” If you check Item 8a, you must indicate where this RFP is available, such as on your website (list the web
address); via the Contact Person listed in Item 6; and/or via the alternative contact person listed in Item 12. If the
RFP is not posted on a website, your designated contact person must be able to provide it to service providers on
request. You must also complete Item 8b with the services you are seeking, whether or not you intend to release an
RFP.
Item 8b – Check this box if you have not released and do not intend to release an RFP for any of the Category One
Services you seek. Whether you check Item 8a or 8b, you must fill in details in the space provided about the specific
Category One services and quantity and/or capacity of service. For example, you might list “monthly Internet
service” under Service, and “for 500 student users” under Quantity and/or Capacity.
Item 9 [Reserved]
Item 10 – Category Two: Internal Connections and Managed Internal Broadband Services. Category Two support is
limited to the internal connections equipment or services necessary to bring broadband into, and provide it
throughout, schools and libraries. Starting in funding year 2015, applicants seeking category two non-recurring
services are permitted to seek support for services purchased on or after April 1, three months prior to the start of
funding year on July 1. Connections are limited to broadband connections used for educational purposes within,
between or among instructional buildings that comprise a school campus or library branch, and basic maintenance of
these connections, as well as services that manage and operate owned or leased broadband internal connections (e.g.,
managed internal broadband services or managed Wi-Fi). Support for components and services in this category are
subject to the funding, budgetary, and other requirements and limitations set forth in the E-rate Modernization Order
(FCC 14-99) and the Commission’s rules. See the Eligible Services List on the USAC website for more information
at http://www.usac.org/sl/applicants/beforeyoubegin/eligible-services-list.aspx.
Item 10a – Check this box if you have released or intend to release an RFP that will provide potential bidders with
specific information about the particular Internal Connections and Managed Internal Broadband services you are
seeking, and what quantity and/or capacity you seek. For example, you might have an RFP that specifies “a router,
hub and cabling to connect one classroom of 30 students.” If you check Item 10a, you must indicate where the RFP
is available, such as on your website (list the web address); via the contact person listed in Item 6; and/or via the
alternative contact person listed in Item 12. If the RFP is not posted on a website, your designated contact person
must be able to provide it to service providers on request. You must also complete Item 10b with the services you are
seeking, whether or not you intend to release an RFP.
Item 10b – Check this box if you have not released and do not intend to release an RFP for any of the Internal
Connections and Managed Internal Broadband services you seek. Whether you check Item 10a or 10b, you must fill
in details in the space provided about the specific services and quantity and/or capacity of service. For example, you
might list “a router, hub and cabling” under Service, and “connecting one classroom of 30 students” under Quantity
and/or Capacity.
Item 11 – Category Two: Basic Maintenance of Internal Connections.
Basic maintenance is eligible for support only if it is a component of a maintenance agreement or contract for eligible
broadband internal connections components. The agreement or contract must specifically identify the eligible
components covered, including product name, model number, and location. Support for basic maintenance will be
paid for the actual work performed under the agreement or contract. See the Eligible Services List on the USAC
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website for more information at http://www.usac.org/sl/applicants/beforeyoubegin/eligible-services-list.aspx.
Item 11a – Check this box if you have released or intend to release an RFP that will provide potential bidders with
specific information about the particular Basic Maintenance services you are seeking, and what quantity and/or
capacity you seek. For example, you might have an RFP for Basic Maintenance that specifies “basic maintenance of
10 routers.” If you check Item 11a, you must indicate where the RFP is available, such as on your website (list the
web address); via the contact person listed in Item 6; and/or via the alternative contact person listed in Item 12. If the
RFP is not posted on a website, your designated contact person must be able to provide it to service providers on
request. You must also complete Item 11b with the services you are seeking, whether or not you intend to release an
RFP.
Item 11b – Check this box if you have not released and do not intend to release an RFP for any of the Basic
Maintenance services you seek. Whether you check Item 11a or 11b, you must fill in details in the space provided
about the specific Basic Maintenance services and quantity and/or capacity of service. For example, you might list
“basic maintenance of routers” under Service, and “for 10 routers” under Quantity and/or Capacity.
Item 12 – You may (but are not required to) provide the name and contact information of the person on your staff or
project who can provide additional technical details or answer specific questions from service providers about the
services you are seeking. This need not be the contact person listed in Item 6 nor the authorized person identified in
Item 27.
Item 13 – Indicate whether you are subject to any state or local restrictions regarding how and when you may be
contacted by potential providers and what bidding procedures they must follow. For example, state bidding
requirements might prohibit contacts between bidders and buyers between the time an official RFP is issued and
when bids are due, or they may allow only written contacts. Applicants must comply with any applicable state or
local requirements when participating in the competitive bidding process used in the universal service
discount mechanism. If you are subject to any state or local restrictions, you must check the box in Item 13 and
provide a description of the restrictions or procedures. Alternatively, you may list a website address where state or
local restrictions can be found and the name and telephone number for a contact person who can provide the state or
local restrictions and the applicable bidding procedures to service providers without Internet access.
If no state or local procurement/competitive bidding requirements apply to this procurement of services and you do
not wish to provide any other information in Item 13, check the second box.
If you are requesting services for a funding year for which an FCC Form 470 cannot yet be filed online, include that
information here.
Block 3: [Reserved]
D.

Block 4: Billed Entities

Item 15 – List here the entity or entities that will be paying bills directly to the service provider(s) for the services
requested in this application. Such entities are known as “billed entities,” and are the entities who file FCC Form
471. List these billed entities, whether or not they themselves are eligible for universal service discounts, and
provide their Entity Numbers. For example, if you are a consortium of school districts joining together to aggregate
demand and thus secure a better price on services that each district will then contract for and pay for individually, list
your member districts and their Entity Numbers in Item 14. As another example, if you are a library whose bills are
paid by the municipal government, you should list the municipal government office and its Billed Entity Number.
List each entity’s name in the right column, and its Entity Number in the left column. If, however, your application is
statewide as indicated in Item 5a, then enter only one billed entity from your state. If you need help identifying
Entity Numbers for each of these billed entities, contact CSB at 1-888-203-8100. Note that funding may be denied
for the FCC Form 471 funding requests associated with this FCC Form 470 if the FCC Form 471 Billed Entity is not
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listed in Item 14.
E.

Block 5: Certifications and Signature

Block 5 requires you to certify certain information to ensure that only eligible entities receive support under the
universal service discount mechanism.
Item 16 – Certify that the entities represented are eligible schools and/or libraries.
Item 17 – [Reserved]
Item 18 – Check this box to certify that you will post your FCC Form 470 and (if applicable) make your RFP
available for at least 28 days before considering all bids received and selecting a service provider in accordance with
program rules unless specifically exempted by program rules from the FCC Form 470 posting requirement.
Item 19 – Check this box to certify that required documents will be retained for a period of at least 10 years (or
whatever retention period is required by the rules in effect at the time of certification) after the last day of service
delivered and to acknowledge that you may be audited pursuant to participation in the schools and libraries program.
Item 20 – Check this box to certify that services you order pursuant to the universal service discount mechanism will
be used primarily for educational purposes and will not be sold, resold, or transferred for gain except as provided in
program rules. Additionally, you certify that the entities listed on this application have not received anything of
value in connection with this request for services.
Item 21 – Check this box to certify that the entity that will be filing the FCC Form 471 can demonstrate that it has
secured access to all of the resources necessary to make effective use of the discounted products and services. You
also certify that the entity has considered what financial resources should be available to cover the costs of these
resources.
Item 22 – Check this box to certify that you are the person authorized to procure eligible services on behalf of the
eligible entity(ies) and are authorized to submit and certify to the accuracy of this form.
Item 23 – Check this box to certify that you have reviewed all applicable competitive bidding requirements, that you
have complied with them, and that you acknowledge that making false statements on this form is punishable by law.
Item 24 – Check this box to certify that you acknowledge that FCC rules provide that persons who have been
convicted of criminal violations or held civilly liable for certain acts arising from their participation in the schools
and libraries support mechanism are subject to suspension and debarment from the program.
Item 25 – Provide the signature of the authorized person.
Item 26 – Insert the date this form was signed by the authorized person.
Item 27a – Print the name of the authorized person whose signature is provided in Item 24.
Item 27b – Provide the title or position of the authorized person whose signature is provided in Item 24. If the
consultant in Item 7 is the Authorized Person, check the appropriate box.
Items 27c-27f – Provide the mailing address, the telephone number, the fax number and the e-mail address of the
authorized person whose signature is provided in Item 24.
Item 27g – Provide the name of the authorized person’s employer. If a consultant is acting as the authorized person,
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this will be the name of the company that employs the consultant and not the name of the applicant organization.
After Completing This Form:
•

When you have completed Blocks 1-4, please print your entire application to retain a copy for your records.

•

You must also submit the Block 5 certification.
•

You may submit your FCC Form 470 certifications online if you have a Personal Identification Number
(PIN). If the authorized person does not yet have a PIN, one will be automatically issued once USAC
successfully processes a paper certification for any FCC Form 470, 471, or 486. The PIN can be used by that
authorized person for any forms filed on behalf of that Billed Entity. When you submit your certifications
online with the PIN, you will receive a confirmation so that you can be assured that your submission has met
any filing deadlines.
If the authorized person has forgotten the PIN and needs USAC to issue a new one, contact CSB at 1-888203-8100. The Change/Disable Applicant PIN tool can be used to disable a PIN, change a PIN or provide a
new e-mail address if the original e-mail address has changed. Mailing addresses cannot be changed, but you
can provide a new e-mail address. The only way to change the mailing address is to file a new form or form
certification on paper and include your mailing address in the authorized person's mailing address fields.
If you certify online, do not mail any part of your FCC Form 470 to USAC.

•

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If you wish to submit the completed and signed Block 5 certification on paper, print Block 5 using the online
instructions for certifying on paper. When you print Block 5, the form will automatically include your FCC
Form 470 Application Number, Applicant Name, and Applicant Address. Item 25 requires the signature of
the authorized person who will certify to the accuracy of the information on the form and Item 26 requires the
date that the certification was signed. Mail the signed Block 5 to: USAC-Form 470, P. O. Box 7026,
Lawrence, Kansas 66044-7026. For express delivery services or U.S. Postal Service Return Receipt
Requested, send to USAC Forms, ATTN: USAC Form 470, 3833 Greenway Drive, Lawrence, KS 66046,
phone 1-888-203-8100. Note: Do not mail the complete FCC Form 470. Mail only the signed Block 5
certification pages. If the Block 5 certification is submitted on paper, you are strongly advised to keep proof
of the date of mailing. No FCC Form 470 certifications will be accepted via e-mail or fax.

FCC Form 470 Instructions — October 2014