FCC Form 481, 54.313/54.422 Data Collection Form

Lifeline Reform and Modernization, Telecommunications Carriers Eligible for Universal Service Support, Connect America Fund

0986_FCCForm481Instructions_072613

FCC Form 481, 54.313/54.422 Data Collection Form

OMB: 3060-0819

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3060-0819 can be found here:

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Instructions for Completing FCC Form 481

OMB Control No. 3060-0986 (High-Cost)

July 2013

Instructions for Completing FCC Form 481

54.313 / 54.422 Data Collection Form

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NOTICE: All eligible telecommunications carriers (ETCs) requesting federal high-cost or low-income universal service support from the Universal Service Administrative Company, the universal service Administrator, shall file this financial and operations information on an annual basis. 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, and from sections 54.313 and 54.422 of the Commission’s rules, 47 C.F.R. §§ 54.313 and 54.422. The data in the form will be used to validate the recipient companies’ support, if any, that it is eligible to receive from the high-cost support mechanism and / or the Lifeline and Link Up support mechanism.

USAC estimates that each response to this collection of information will take, on average, 133 hours for a high-cost recipient, and 3 hours for a Lifeline-only recipient. USAC’s 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, Paperwork Reduction Project (3060-0986), Washington, D.C. 20554. We also will accept your comments via email 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 3060-0986 for high-cost recipients.

The Commission is authorized under the Communications Act of 1934, as amended, to collect the information requested in this form. Provided information will be used to determine high-cost support mechanism and Lifeline support mechanism amounts. If USAC believes 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 and/or Lifeline support mechanisms, 47 C.F.R. Parts D and E.

The foregoing Notice is required by the Paperwork Reduction Act of 1995, P.L. No. 104-13, 44 U.S.C. § 3501, et seq.

Specific Instructions

I. Introduction and Background

Eligible telecommunications carriers (ETCs) that receive federal high-cost universal service support (high-cost support) are required to provide the data identified in 47 C.F.R. § 54.313.^¹ Lifeline-only ETCs that receive only low-income support through the federal Lifeline program (low-income support) are required to provide the data identified in 47 C.F.R. § 54.422.^² ETCs that receive both high-cost support and low-income support should follow the high-cost and low-income support requirements. ETCs that receive only low-income support should follow only the low-income support requirements. These annual reports are intended to assure compliance with the Federal Communications Commission’s (FCC) rules and progress toward its universal service goals.

II. The Carrier or the Carrier’s Agent May File This Form

As an ETC, you may choose to complete this filing directly and submit it to the FCC, the Universal Service Administrative Company (USAC), the universal service Administrator, and the relevant state commissions, relevant authority in a U.S. Territory, or Tribal governments, as appropriate. Alternatively, you can elect to designate an agent to execute the compliance filing on your behalf and submit it to the FCC, USAC, and the relevant state commissions, relevant authority in a U.S. Territory, or Tribal governments, as appropriate. Please note that, if you choose to designate an agent to complete and submit FCC Form 481 on your behalf, an authorized officer of your company must advise USAC of the identity of your agent, and certify that the actual data provided to your authorized agent is accurate to the best of his/her knowledge. Your authorized agent must:

Certify that he/she is authorized to submit the information on behalf of the reporting ETC;
Certify that the data provided on the form are based on actual operational data received from the reporting ETC;
Certify that the information on the form is accurate to the best of the agent’s knowledge; and
Provide copies of the compliance filing to the reporting ETC within 15 days.

Certifications are subject to the penalties for false statements imposed under 18 U.S.C. § 1001.^³

III. When Must ETCs Make These Compliance Filings

Reporting Requirements for High-Cost Recipients

Section 54.313 requires all ETCs receiving high-cost support to file annual reports regarding compliance with the Commission’s rules and progress toward its universal service goals.^⁴ This section does not apply to ETCs that only receive Mobility Fund Phase I support, who must file annual reports, FCC Form 690, pursuant to section 54.1009.^⁵
Section 54.313 annual reports are due annually on July 1^st each year.^⁶
ETCs must file with the Office of the Secretary of the FCC, clearly referencing WC Docket No. 10-90, and with USAC, and send copies to the relevant state commission, relevant authority in a U.S. Territory, or Tribal government, as appropriate.^⁷ See section IV below for specific filing instructions.
Any new reporting requirements are not effective until Federal Register publication of approval by the Office of Management and Budget.
ETCs receiving high-cost support for voice telephony service and offering broadband as a condition of receiving such support must report with respect to broadband service offered by the ETC directly to end-user customers and/or an Internet service provider that provides retail broadband Internet access service to end-user customers in satisfaction of the ETC’s broadband obligations.
ETCs receiving high-cost support for voice telephony service and offering broadband as a condition of such support, must file with the Commission, relevant state commission, relevant authority in a U.S. Territory, or Tribal government, as appropriate, a five-year build-out plan that accounts for the new broadband obligations adopted in the USF/ICC Transformation Order.^⁸ Section 54.313(a)(1) requires such ETCs to file annual progress reports on their five-year build-out plans in subsequent years.^⁹ Competitive ETCs whose support is being phased down are not required to submit a new five-year build-out plan, but must continue to submit information or certifications with respect to their provision of voice service, including filing progress reports on any previously filed five-year build-out plans.^¹⁰
Sections 54.313(a)(2)-(4) require ETCs annually to file information concerning outages, unfulfilled service requests, and complaints.^¹¹ ETCs must separately file these data for voice and broadband service,^¹² except that, at this time, ETCs are not required to submit outage information regarding their broadband service.^¹³
Sections 54.313(a)(5)-(6) require ETCs to make certifications as to their compliance with applicable service quality standards and consumer protection rules, and their ability to remain functional in emergency situations as set forth in section 54.202(a)(2).^¹⁴ ETCs must separately file these data for voice and broadband service.^¹⁵
Section 54.313(a)(7) requires ETCs to report their voice price offerings and broadband price offerings.^¹⁶ ETCs should report rates in effect as of January 1 of the reporting year.
Section 54.313(a)(8) requires ETCs, beginning July 1, 2013, and annually thereafter, to report ownership information.^¹⁷
Section 54.313(a)(9) requires ETCs, to the extent they serve Tribal lands, to undertake their Tribal engagement obligations pursuant to the Office of Native Affairs and Policy (ONAP) guidance.^¹⁸
Section 54.313(a)(10) requires ETCs to certify that the pricing of their voice services are no more than two standard deviations above the applicable national average urban rate for voice service, which will be specified annually in a public notice issued by the FCC’s Wireline Competition Bureau.^¹⁹
Section 54.313(a)(11) requires ETCs to submit the results of network performance tests pursuant to the methodology and in the format determined by the Commission’s Wireline Competition Bureau, Wireless Telecommunications Bureau, and Office of Engineering and Technology.^²⁰ At this time, ETCs are not required to submit any information pursuant to this section.
Section 54.313(b) requires any recipient of incremental Connect America Phase I support pursuant to section 54.312(b) to provide certain certifications related to their broadband obligations.^²¹
Section 54.313(c) requires price cap ETCs that receive frozen high-cost support pursuant to section 54.312(a) to provide certain annual certifications related to their broadband obligations.^²²
Section 54.313(d) requires price cap ETCs that receive high-cost support to offset reductions in access charges to provide certain certifications related to their broadband obligations.^²³
Section 54.313(e) requires recipients of Connect America Phase II support to provide certain certifications related to their broadband obligations.^²⁴
Section 54.313(f) requires rate-of-return ETCs to provide certain certifications related to their broadband obligations.^²⁵
Section 54.313(f)(2) requires privately held rate-of-return ETCs, beginning in July 1, 2013, and annually thereafter, to file financial reports.^²⁶
- Privately held rate-of-return ETCs that receive loans from the Rural Utilities Service (RUS) must file electronic copies of their annual RUS reports (Operating Report for Telecommunications Borrowers).
- All privately held rate-of-return ETCs that are not recipients of loans from the RUS and whose financial statements are audited in the ordinary course of business must provide either: (1) a copy of their audited financial statement; or (2) a financial report in a format comparable to RUS Operating Report for Telecommunications Borrowers, accompanied by a copy of a management letter issued by the independent certified public accountant that performed the company’s financial audit.
- All other privately held rate-of-return ETCs must provide either: (1) a copy of their financial statement which has been subject to review by an independent certified public accountant; or (2) a financial report in a format comparable to RUS Operating Report for Telecommunications Borrowers, with the underlying information subjected to a review by an independent certified public accountant and accompanied by an officer certification that: (a) the carrier was not audited in the ordinary course of business for the preceding fiscal year; and (b) that the reported data are accurate.
Section 54.313(g) requires ETCs without access to terrestrial backhaul to certify they offer broadband service of at least 1 Mbps/256 kbps within the supported area served by satellite middle-mile facilities.
Section 54.313(h) requires all incumbent local exchange carriers receiving high-cost support to report all of their rates for residential local service for all portions of their service area, as well as state fees, to the extent the sum of those rates and fees are below the rate floor, and the number of lines for each rate specified.^²⁷ ETCs shall report lines and rates in effect as of June 1 of the reporting year. For these purposes, state regulated fees are limited to state subscriber line charges, state universal service fees and mandatory extended area service charges. Federal subscriber line charges and federal universal service fees are not included. In addition to the annual filing, local exchange carriers may file updates of their rates for residential local service, as well as state fees, on January 2 of each year. If a local exchange carrier reduces its rates and the sum of the reduced rates and state fees are below the rate floor, the local exchange carrier shall file such an update. For the update, carriers shall report lines and rates in effect as of December 1.
- ETCs subject to section 54.313(h) should file separately with USAC their rates and line counts on the Rate Floor Data Collection form.

Reporting Requirements for Low-Income Recipients

Section 54.422 requires ETCs receiving low-income support (as per subpart E of the rules) to file annual reports reporting and certifying to certain information.^²⁸
Section 54.422 annual reports are due annually on July 1^st each year.
ETCs must file with the Office of the Secretary of the Commission and with the Administrator, and send copies to the relevant state commission, relevant authority in a U.S. Territory, or Tribal government, as appropriate.^²⁹
Section 54.422(a)(1) requires all such ETCs to report ownership information.^³⁰
Section 54.422(a)(2) requires all such ETCs to report the terms and conditions of any voice telephony service plans offered to Lifeline subscribers.^³¹
Section 54.422(b) requires ETCs designated by the FCC under section 214(e)(6) of the Act that receive only low-income support and do not receive high-cost support to file the following information {previously filed for section 54.209 compliance}:^³²

Information regarding service outages,
Number of complaints received per 1,000 connections,
Certification of compliance with applicable service quality standards and consumer protection rules
Certification that the carrier is able to function in emergency situations.

IV. Filing Instructions

As an ETC, you must file this form with the FCC, USAC (the universal service Administrator), and the relevant state commission, relevant authority in a U.S. Territory, or Tribal governments, as appropriate. ETCs may complete this form online at www.usac.org, and print out the completed form, which can then be submitted to the FCC via its Electronic Comment Filing System (ECFS), http://apps.fcc.gov/ecfs/, and must clearly reference WC Docket No. 10-90. Parties who choose to file by paper with the FCC must file an original and one copy of each filing.

Filings can be sent by hand or messenger delivery, by commercial overnight courier, or by first-class or overnight U.S. Postal Service mail. All filings must be addressed to the Commission’s Secretary, Office of the Secretary, Federal Communications Commission.
All hand-delivered or messenger-delivered paper filings for the Commission’s Secretary must be delivered to FCC Headquarters at 445 12^th St., SW, Room TW-A325, Washington, DC 20554. The filing hours are 8:00 a.m. to 7:00 p.m. All hand deliveries must be held together with rubber bands or fasteners. Any envelopes and boxes must be disposed of before entering the building.
Commercial overnight mail (other than U.S. Postal Service Express Mail and Priority Mail) must be sent to 9300 East Hampton Drive, Capitol Heights, MD 20743.
U.S. Postal Service first-class, Express, and Priority mail must be addressed to 445 12^th Street, SW, Washington DC 20554.

Parties seeking confidential treatment of portions of their FCC Form 481 should file with the FCC pursuant to section 0.549 of the FCC’s rules.^³³

Parties should follow the local rules to file with their relevant state commission, relevant authority in a U.S. Territory, or Tribal governments, as appropriate.

Annual Reporting for All Carriers

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Line 030 – Contact Name: Provide the name of the individual that prepared the data submission for your company. Providing this information will assist in resolving any issues or questions that may arise from the data submission.

Line 035 – Contact Phone Number: Provide the telephone number of the individual that prepared the data submission for your company. Providing this information will assist in resolving any issues or questions that may arise from the data submission.

Line 039 – Contact Email Address: Provide the email address of the individual that prepared the data submission for your company. Providing this information will assist in resolving any issues or questions that may arise from the data submission.

Line 100 – Service Quality Improvement Reporting: ETCs receiving high-cost support for voice telephony service and offering broadband as a condition of such support, must file with the Commission, relevant state commission, relevant authority in a U.S. Territory, or Tribal government, as appropriate, a five-year build-out plan that accounts for the new broadband obligations adopted in the USF/ICC Transformation Order. Section 54.313(a)(1) requires such ETCs to file annual progress reports on their five-year build-out plans in subsequent years. Competitive ETCs whose support is being phased down are not required to submit a new five-year build-out plan, but must continue to submit information or certifications with respect to their provision of voice service, including filing progress reports on any previously filed five-year build-out plans. Note the completion of the required five-year plan or progress report, as appropriate. The progress report should include maps detailing your progress towards meeting your plan targets, an explanation of how much universal service support was received and how it was used to improve service quality, coverage, or capacity, and an explanation regarding any network improvement targets that have not been fulfilled in the prior calendar year. The information must be submitted at the wire center level or census block, as appropriate.

Line 200 – Voice Telephony Service Outage Reporting: As defined in 47 C.F.R. § 54.313(a)(2)(i)&(ii){for High-cost Recipients} and 47 C.F.R. § 54.422(b)(1){for Low-income Only Recipients }, your company must describe any outage of voice telephony service in the prior calendar year for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize.

Line 210 – Outage Reporting: Mark this “box” if you had NO reportable voice service outages in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(2)(i) & (ii){for High-cost Recipients} and 47 C.F.R. § 54.422(b)(1){for Low-income Only Recipients }, for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize.

Line 300 – Unfulfilled Voice Telephony Service Requests: Note the quantity of requests for voice telephony service from potential customers within your service areas that were un-fulfilled in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(3), for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize.

Line 310 – Unfulfilled Voice Telephony Service Requests Resolution: Mark this “box” to verify you provided a detailed description of how you attempted to provide service to potential customers whose initial requests for service were unfulfilled in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(3), for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize. Your description of the resolution should provide no information which is considered to be customer proprietary network information (CPNI); only the generic process utilized should be delineated.

Line 320 – Unfulfilled Broadband Service Requests: Note the quantity of requests for broadband service from potential end-user customers within your service areas that were un-fulfilled in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(3), for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize.

Line 330 – Unfulfilled Broadband Service Requests Resolution: Mark this “box” to verify you provided a detailed description of how you attempted to provide broadband service to potential end-user customers whose initial requests for service were unfulfilled in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(3), for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize. Your description of the resolution should provide no information which is considered to be CPNI; only the generic process utilized should be delineated.

Line 400 – Number of Complaints per 1,000 Customers (Voice Telephony Service): Mark this “box” to verify you are reporting of customer complaints for voice telephony service in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients} and 47 C.F.R. § 54.422(b)(2){for Low-income Only Recipients }, for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize.

Line 410 – Number of Complaints per 1,000 Customers (Fixed Voice Telephony Service): Note the quantity of fixed voice telephony service customer complaints in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients} and 47 C.F.R. § 54.422(b)(2){for Low-income Only Recipients }, for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize. Leave empty if not applicable.

Line 420 – Number of Complaints per 1,000 Customers (Mobile Voice Telephony Service): Note the quantity of mobile voice telephony service customer complaints in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients} and 47 C.F.R. § 54.422(b)(2){for Low-income Recipients }, for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize. Leave empty if not applicable.

Line 430 – Number of Complaints per 1,000 Customers (Broadband Service): Mark this “box” to verify you are reporting of end-user customer complaints for broadband service in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients}, for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize.

Line 440 – Number of Complaints per 1,000 Customers (Fixed Broadband Service): Note the quantity of fixed broadband service end-user customer complaints in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients}, for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize. Leave empty if not applicable.

Line 450 – Number of Complaints per 1,000 Customers (Mobile Broadband Service): Note the quantity of mobile broadband service end-user customer complaints in the prior calendar year, as defined in 47 C.F.R. § 54.313(a)(4) {for High-cost Recipients}, for each service area in which you are designated an ETC for any facilities you own, operate, lease, or otherwise utilize. Leave empty if not applicable.

Line 500 – Compliance with Service Quality Standards and Consumer Protection Certification: Mark this “box” to certify your compliance with applicable service quality standards and consumer protection rules, as required in 47 C.F.R. § 54.313(a)(5) {for High-cost Recipients} and 47 C.F.R. § 54.422(b)(3){for Low-income Only Recipients}.

Line 510 – Description of Compliance with Service Quality Standards and Consumer Protection: Provide a detailed description of how you complied with the applicable service quality standards and consumer protection rules, as required in 47 C.F.R. § 54.313(a)(5) {for High-cost Recipients} and 47 C.F.R. § 54.422(b)(3){for Low-income Only Recipients }.

Line 600 – Functionality in Emergency Situations Certification: Mark this “box” to certify you are able to function in emergency situations, as required in 47 C.F.R. § 54.313(a)(6) {for High-cost Recipients} and 47 C.F.R. § 54.422(b)(4){for Low-income Only Recipients } and set forth in 47 C.F.R. § 54.202(a)(2).

Line 610 – Description of Functionality in Emergency Situations: Provide a detailed description of how you are able to function in emergency situations, as required in 47 C.F.R. § 54.313(a)(6) {for High-cost Recipients} and 47 C.F.R. § 54.422(b)(4){for Low-income Only Recipients } and set forth in 47 C.F.R. § 54.202(a)(2).

Line 700 – Company Voice Telephony Service Price Offerings: Note the completion of the attached worksheet certification which reports your voice telephony service price offerings as required in 47 C.F.R. § 54.313(a)(7).

Line 710 – Company Broadband Service Price Offerings: Note the completion of the attached worksheet certification which reports your broadband service price offerings as required in 47 C.F.R. § 54.313(a)(7).

Line 800 – Operating Company and Affiliates: Note the completion of the attached worksheet which reports your holding company, operating companies, affiliates, as defined under section 3 of the Communications Act, and any branding (a “dba,” or “doing-business-as company” or brand designation), as well as universal service identifiers for each such entity by Study Area Codes, as that term is used by the Administrator as required in 47 C.F.R. § 54.313(a)(8){for High-cost Recipients} and 47 C.F.R. § 54.422(a)(1){for Low-income Only Recipient Companies}. For purposes of this requirement, you are required to report all affiliates that are designated as ETCs or that provide retail broadband Internet access to end-user customers.

Line 900 – Tribal Land Offerings: If you provide service on Tribal Lands, note the completion of the required documents which validates your engagement with Tribal Governments, as required in 47 C.F.R. § 54.313(a)(9).

Line 1000 – Voice Services Rate Comparability Certification: Mark this “box” to certify that your pricing of fixed voice services is no more than two standard deviations above the applicable national average urban rate for voice service, as published annually by the Wireline Competition Bureau, as required in 47 C.F.R. § 54.313(a)(10).

Line 1010 – Description of Voice Services Rate Comparability: Provide a detailed description of how your pricing of fixed voice services is no more than two standard deviations above the applicable national average urban rate for voice service, as published annually by the Wireline Competition Bureau, as required in 47 C.F.R. § 54.313(a)(10).

Line 1100 – Terrestrial Backhaul Certification: Mark this “box” to certify that you have no options for terrestrial backhaul access to the network and are compelled to rely exclusively on satellite backhaul in your service area, as required in 47 C.F.R. § 54.313(g).

Line 1110 – Description of Terrestrial Backhaul: Provide a detailed description of how you have no options for terrestrial backhaul access to the network and are compelled to rely exclusively on satellite backhaul in your service area, as required in 47 C.F.R. § 54.313(g).

Line 1200 – Terms and Conditions for Lifeline Customers: Mark this “box” to verify your completion of the worksheet containing the information describing the terms and conditions of any voice telephony service plans offered to Lifeline subscribers, or, if such plans are generally available to the public, provide a link to a public website outlining the terms and conditions of such plans, as required in 47 C.F.R. § 54.422(a)(2).

Specific Carrier Reporting

Line 2000 – Price Cap Carriers’ Additional Documentation Certification: Mark this “box” to certify the validity of the data provided in the required worksheets which consolidate your information and certifications as a recipient, as applicable, of incremental Connect America Phase I support, frozen high-cost support, Connect America Fund ICC support, and Connect America Phase II support. These requirements are cited in 47 C.F.R. §§ 54.313(b),(c),(d) & (e).

Line 2005 – Price Cap Carriers’ Additional Documentation Certification: Mark this “box” to acknowledge you have completed the required worksheets which consolidate your information and certifications as a recipient, as applicable, of incremental Connect America Phase I support, frozen High-cost support, Connect America Fund ICC support, and Connect America Phase II support. These requirements are cited in 47 C.F.R. §§ 54.313(b),(c),(d) & (e).

Line 3000 – Rate of Return Carriers’ Additional Documentation Certification: Mark this “box” to certify the validity of the data provided in the required worksheets which consolidate your Rate of Return information and certifications, as applicable. These requirements are cited in 47 C.F.R. § 54.313(f).

Line 3005 – Rate of Return Carriers’ Additional Documentation: Mark this “box” to acknowledge you have completed the required worksheets which consolidate your Rate of Return information and certifications, as applicable. These requirements are cited in 47 C.F.R. § 54.313(f).

Annual Reporting for All Recipients of High-Cost Support – Service Quality Improvement Plan Report (100)

Filing Regulations: 47 C.F.R. §54.313(a)(1); 47 C.F.R. §54.202(a)(1)(ii)

Purpose: ETCs receiving high-cost support for voice telephony service and offering broadband as a condition of such support, must file with the Commission, relevant state commission, relevant authority in a U.S. Territory, or Tribal government, as appropriate, a five-year build-out plan that accounts for the new broadband obligations adopted in the USF/ICC Transformation Order, in a manner consistent with section 54.202(a)(1)(ii). Section 54.313(a)(1) requires such ETCs to file annual progress reports on their five-year build-out plans in subsequent years. Competitive ETCs whose support is being phased down are not required to submit a new five-year build-out plan, but must continue to submit information or certifications with respect to their provision of voice service, including filing progress reports on any previously filed five-year build-out plans. An ETC’s annual update must include maps explaining its progress towards meeting its deployment targets, amount of universal service support received, how support was used to improve service quality, coverage, or capacity, and an explanation regarding any network improvement targets that have not been fulfilled in the prior calendar year. The information shall be submitted at the wire center level or census block as appropriate.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s High-cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Line 110 – ETC Certification from FCC: Confirm (yes / no) if your company received its ETC certification from the FCC.

Line 111 – Five-year Plan filed with FCC: Confirm (yes / no) if your company has an existing § 54.202(a) "five-year plan" filed with the FCC.

Line 112 – Five-year Plan or Progress Report: Please attach your company’s five-year build-out plan, as appropriate. Note that while ETCs are free to submit maps with their five-year plans, maps are not required for the initial plan; ETCs may provide a narrative description of their intended plans. Five-year plans should “estimate the area and population that will be served as a result of the improvements.”^³⁴ Recipients may describe where improvements are expected to occur by wire center or census block, as appropriate. To the extent no improvements are planned in specific areas, the five-year plan should so indicate.

In subsequent years, please attach a document that describes your company’s progress report on the five-year plan, pursuant to 47 C.F.R. §54.313(a)(1),^³⁵ including maps explaining your progress towards meeting your deployment targets, the amount of universal service support received, how support was used to improve service quality, coverage, or capacity, and an explanation regarding any network improvement targets that have not been fulfilled in the prior calendar year. The information regarding the total amount of universal service support received shall also be broken out separately by the amount spent on capital expenses and the amount spent on operating expenses. The information regarding planned and/or completed network improvements shall be at the wire center level or census block, as appropriate.

Line 113 – Five-year Plan Progress Report contains required maps: Please check this box to confirm that, if the attached PDF on line 112 is a progress report, it contains maps detailing progress towards meeting plan targets at the wire center level or census block as appropriate.

Line 114 – Five-year Plan Progress Report quantifies USF support received: Please check this box to confirm that, if the attached PDF on line 112 is a progress report, it quantifies how much USF was received for your service area and is broken out separately by the amount spent on capital expenses and the amount spent on operating expenses.

Line 115 – Five-year Plan Progress Report quantifies USF support which improves Service Quality: Please check this box to confirm that, if the attached PDF on line 112 is a progress report, it specifies how much USF was used to improve service quality, at the wire center level or census block as appropriate.

Line 116 – Five-year Plan Progress Report quantifies USF support which improves Service Coverage: Please check this box to confirm that, if the attached PDF on line 112 is a progress report, it specifies how much USF was used to improve service coverage, at the wire center level or census block as appropriate.

Line 117 – Five-year Plan Progress Report quantifies USF support which improves Service Capacity: Please check this box to confirm that, if the attached PDF on line 112 is a progress report, it specifies how much USF was used to improve service capacity, at the wire center level or census block as appropriate.

Line 118 – Explanation of Network Improvement Targets not achieved: Please check this box to confirm that, if the attached PDF on line 112 is a progress report, it reports any reasons network improvement objectives were not achieved, at the wire center level or census block as appropriate.

Annual Reporting for All Recipients of Either High-Cost or Lifeline Support – Service Outage Reporting (200)

Filing Regulations: 47 C.F.R. §54.313(a)(2); 47 C.F.R. §54.422(b)(1)

Purpose: ETCs must report any service outage, in this study area, which occurred in the prior calendar year. It is deemed a reportable incident (as per 47 C.F.R. §4.5) if it has a duration of at least 30 minutes and impacts at least ten percent of the end users served in the service area or 911 special facility. The data collected on this page should be consistent with the data reported on the Network Outage Reporting System (NORS).
See http://transition.fcc.gov/pshs/services/cip/nors/nors.html

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

{Note: Each line with the worksheet should cover a single reportable service outage incident; if the lines of data extend beyond the bottom of the worksheet, it will be found on a separate attachment}

Line 220 – Column a – NORS Reference Number: Input the reference number associated with the data, for this outage incident, reported on the Network Outage Reporting System.

Line 220 – Column b1 – Outage Start Date: Input the date (format: mm/dd/2012) of the onset of the service outage.

Line 220 – Column b2 – Outage Start Time: Input the time (24 hour format: hh/mm) of the onset of the service outage.

Line 220 – Column b3 – Outage End Date: Input the date (format: mm/dd/2012) of the end of the service outage.

Line 220 – Column b4 – Outage End Time: Input the time (24 hour format: hh/mm) of the end of the service outage.

Line 220 – Column c1 – Number of Customers Affected: Input the total number of customers affected at any time during the service outage.

Line 220 – Column c2 – Total Number of Customers: Input the amount of the study area’s total customer base.

Line 220 – Column d – 911 Facilities Affected (yes/no): Confirm whether this outage impacted the 911 facilities’ functionality at any time during the service outage.

Line 220 – Column e – Service Outage Description: Select the services impacted by the service outage. Select from the drop down box (check all that apply) from the following options: Wireline (including cable) VoIP; Wireline (including cable) Voice (non-VoIP); Cellular; Voice Over LTE (VoLTE), 911, E911 or NG911 Services only; and Other (limit the field to 50 characters at most)

Line 220 – Column f – Did this Service Outage Affect Multiple Study Areas: Confirm (yes / no) if this service outage affected multiple study areas.

Line 220 – Column g – Service Outage Resolution: Provide a brief description of the processes used to resolve the service outage.

Line 220 – Column h – Preventative Procedures: Provide a brief description of the preventative procedures implemented by the carrier to avoid the occurrence of a similar service outage in the future.

Annual Reporting by All Recipients of High-Cost Support – Company Voice Price Offerings (700)

Filing Regulations: 47 C.F.R. §54.313(a)(7)

Purpose: ETCs must report their voice telephony service price offerings. ETCs must report local service rates and state fees in effect as of January 1^st of the reporting year.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s High Cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name that you use to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Line 701 – Residential Local Service Charge Effective Date: Provide the effective date, January 1^st of the reporting year, of the local service rates which has been approved by the state or territorial regulatory agency with jurisdiction.

Line 702 – Single State-wide Residential Local Service Charge: Mark this “box” to certify that your company has a single state-wide local service charge which has been approved by the state or territorial regulatory agency with jurisdiction. {note: only populate a single line of data in the line 703 worksheet}

{Note: For incumbent carriers: If you do not have a single, state-wide local service charge, you must separately report the rate for each exchange. Each line with the worksheet (at line 703) should cover a single exchange’s rate. For CETCs: Each line with the worksheet should cover a residential rate level which applies to the entire study area; if the lines of data extend beyond the bottom of the worksheet, it will be found on a separate attachment.}

Line 703 – Column a1 – State: The state where your study area is located.

Line 703 – Column a2 – Exchange (ILEC): For ILECs, provide the exchange name associated with this line of data within the worksheet.

Line 703 – Column a3 – SAC (CETC): For CETCs, provide the study area code (SAC) associated with this line of data within the worksheet.

Line 703 – Column b1 – Rate Type: Provide the type residential local service (flat rate / measured / metered) which the ETC provides to the customers identified as per the January 1st access line count of the Program Year.

Line 703 – Column b2 - Residential Rate: For the wire center or census block cited in column “a2”, report each of your company’s voice telephony service price offerings. In addition, report your company’s rates in effect as of January 1 of the reporting year for residential local service for all portions of your service area, as well as state fees, as specified below. State regulated fees are limited to state subscriber line charges, state universal service fees and mandatory extended area service charges. Other state fees, such as state 911 fees, may not be included. Federal subscriber line charges are not included.

For local service provided pursuant to measured or message rate plans – in which customers do not receive unlimited local calling, but instead pay a per-minute or per-call charge for some or all calls – the local service rate reported by ETCs should reflect the basic rate for local service plus the additional charges incurred for measured service, using the mean number of minutes or message units for all customers subscribing to that rate plan multiplied by the applicable rate per minute or message unit.

For customers subscribing to bundled service, ETCs should report the local service rate as tariffed, if applicable, or as itemized on end-user bills. If an ETC neither tariffs nor itemizes the local voice service rate on bills for bundled services, it may report the rate of a similar stand-alone local voice service that it offers to consumers in that study area.

Line 703 – Column b3 – State Subscriber Line Charge: For the wire center / census block cited in column “a2”, provide the approved state commission subscriber line charge.^³⁶ The amounts should be reported on a per-line basis.

Line 703 – Column b4 – State Universal Service Fee: For the wire center / census block cited in column “a2”, provide the approved state commission universal service fee.^³⁷ The amounts should be reported on a per-line basis.

Line 703 – Column b5 – Mandatory Extended Area Service Charge: For the wire center / census block cited in column “a2”, provide any approved state commission “mandatory” extended area service charges.^³⁸ The amounts should be reported on a per-line basis.

Line 703 – Column c – Total Per-Line Fees: The calculated total of the per-line amounts in columns “b2” through “b5”.

Annual Reporting by Recipients of High-Cost Support – Company Broadband Price Offerings (710)

Filing Regulations: 47 C.F.R. §54.313(a)(7)

Purpose: Incumbent ETCs must report the broadband service price offerings for the provision of retail broadband Internet access to end-user customers. Report each broadband service offering that meets or exceeds the high-cost speeds and usage allowance (if any) requirements and the corresponding rate, as of January 1^st of the reporting year. CETCs are not required to provide this information.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s High Cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name that you use to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

{Note: Separately report each broadband service offering that meets or exceeds the high-cost speeds and usage allowance (if any) requirements. A service offering is a service at a particular speed and usage allowance, if any. If uniform broadband rates are not offered throughout your service area, you must separately report each rate for each service for each exchange. Each line with the worksheet should cover a residential rate level which applies to that exchange; if the lines of data extend beyond the bottom of the worksheet, it will be found on a separate attachment. If uniform broadband rates are offered throughout your service area, only populate a single line of data for each of those service offerings and enter “ALL” in column a2.}

Line 711 – Column a1 – State: The state where your study area is located.

Line 711 – Column a2 – Exchange (ILEC): Provide the exchange name associated with this line of data within the worksheet. Enter “ALL” in this field if the broadband service offering you are entering on this line of data is offered throughout your service area.

Line 711 – Column b1 - Residential Rate: Report the total rate offered to residential end-user customers for each broadband service at a given speed (and usage allowance, if any) that meets or exceeds the high-cost broadband service requirements.

Line 711 – Column b2 – State Regulated Fees: Report the sum of any relevant state regulated fees, if any, charged to the customer as a separate line item.

Line 711 – Column c – Total Rates and Fees: The calculated sum of columns “b1” and “b2” per line amounts.

Line 711 – Column d1 – Broadband Service Download Speed: Report the broadband service download speed at this reported rate (report in Megabits per second, or Mbps).

Line 711 – Column d2 – Broadband Service Upload Speeds: Report the broadband service upload speed at this reported rate (report in Megabits per second, or Mbps).

Line 711 – Column d3 – Usage allowance(s): Report usage allowance(s), if any, for the broadband service offered at this reported rate (Gigabits).

Line 711 – Column d4 – Usage allowance(s) Action Taken When Limit Reached: Select the action taken once usage allowance is reached; Identify your response from the choice of “Overage Charge,” “Blocking Traffic,” “Rate-limiting ,”or “Other (please include brief explanation).”

Annual Reporting By All Recipients of Either High-Cost or Lifeline Support – Operating Companies and Affiliates (800)

Filing Regulations: 47 C.F.R. §54.313(a)(8); 47 C.F.R. §54.422(a)(1)

Purpose: ETCs must report their holding company, operating companies, affiliates, as defined under section 3 of the Communications Act, and any branding (a “dba,” or “doing-business-as company” or brand designation), as well as universal service identifiers for each Study Area Code.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Line 810 – Reporting Carrier: The regulatory identifying name associated with the study area reported in this document.

Line 811 – Holding Company: The name of the corporate holding company associated with the study area reported in this document.

Line 812 – Operating Company: The name of the corporate operating company designation associated with the study area reported in this document.

{Note: if the lines of data extend beyond the bottom of the worksheet, it will be found on a separate attachment}

Line 813 – Column a1 – Affiliates: The name of any corporate affiliates associated with the study area reported in this document. The term “affiliates” has the meaning set forth in section 3(2) of the Act. For purposes of this requirement, you are required to report all affiliates that are designated as ETCs, and their SACs, or that provide retail broadband Internet access to end-user customers.

Line 813 – Column a2 – Affiliates’ Study Area Code (SAC): Provide the SAC associated with the affiliate ETCs.

Line 813 – Column a3 – Brand Designation: For the affiliate ETC listed in column a1, provide the alternative corporate branding or legal “Doing Business As” designations associated with the study area reported in this document. “Doing Business As” includes brand identifiers for any product offered in that Study Area Code.

Annual Reporting By Recipients of High-Cost Support – Tribal Lands (900)

Filing Regulations: 47 C.F.R. §54.313(a)(9)

Purpose: To the extent that the ETC serves Tribal lands, documents or information demonstrating that it has engaged with Tribal governments, as appropriate.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s High Cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Line 910 – Tribal Land(s): Identify the Tribal Land(s) on which your company provides service.

Line 920 – Tribal Engagement: Please attach a document that your company has had discussions with Tribal governments that, at a minimum, included:^³⁹ (i) A needs assessment and deployment planning with a focus on Tribal community anchor institutions; (ii) Feasibility and sustainability planning; (iii) Marketing services in a culturally sensitive manner; (iv) Rights of way processes, land use permitting, facilities siting, environmental and cultural preservation review processes; and (v) Compliance with Tribal business and licensing requirements. Tribal business and licensing requirements include business practice licenses that Tribal and non-Tribal business entities, whether located on or off Tribal lands, must obtain upon application to the relevant Tribal government office or division to conduct any business or trade, or deliver any goods or services to the Tribes, Tribal members, or Tribal lands. These include certificates of public convenience and necessity, Tribal business licenses, master licenses, and other related forms of Tribal government licensure.

Line 921 – Needs Assessment and Deployment Planning: Please respond (either yes, no, or n/a) in this box to explain as to whether the attached PDF, on line 920, contains an explanation of your company’s actions to address needs assessment and deployment planning with a focus on Tribal community anchor institutions for the Tribal land network.

Line 922 – Feasibility and Sustainability Planning: Please respond (either yes, no, or n/a) in this box to explain as to whether the attached PDF, on line 920, contains an explanation of your company’s actions to address feasibility and sustainability planning for the Tribal land network.

Line 923 – Marketing Services in a Culturally Sensitive Manner: Please respond (either yes, no, or n/a) in this box to explain as to whether the attached PDF, on line 920, contains an explanation of your company’s actions to address the marketing of services in a culturally sensitive manner in the Tribal land.

Line 924 – Compliance with Right of Way Processes: Please respond (either yes, no, or n/a) in this box to explain as to whether the attached PDF, on line 920, contains an explanation of your company’s actions to comply with the right-of-way processes for the Tribal lands.

Line 925 – Compliance with Land Use Permitting Requirements: Please respond (either yes, no, or n/a) in this box to explain as to whether the attached PDF, on line 920, contains an explanation of your company’s actions to comply with the land use permitting requirements for the Tribal lands.

Line 926 – Compliance with Facility Siting Rules: Please respond (either yes, no, or n/a) in this box to explain as to whether the attached PDF, on line 920, contains an explanation of your company’s actions to comply with the facilities siting rules for the Tribal lands.

Line 927 – Compliance with Environmental Review Processes: Please respond (either yes, no, or n/a) in this box to explain as to whether the attached PDF, on line 920, contains an explanation of your company’s actions to comply with the environmental review processes for the Tribal lands.

Line 928 – Compliance with Cultural Preservation Review Processes: Please respond (either yes, no, or n/a) in this box to explain as to whether the attached PDF, on line 920, contains an explanation of your company’s actions to comply with the cultural preservation review processes for the Tribal lands.

Line 929 – Compliance with Tribal Business and Licensing Requirements: Please respond (either yes, no, or n/a) in this box to explain as to whether the attached PDF, on line 920, contains an explanation of your company’s actions to comply with the Tribal business and licensing requirements for the Tribal lands.

Annual Reporting By Recipients of High-Cost Support – No Terrestrial Backhaul (1110)

Filing Regulations: 47 C.F.R. §54.313(g)

Purpose: ETCs must note they have no access to terrestrial backhaul and validate their ability to offer broadband service of at least 1 Mbps/256 kbps within the supported area served by satellite middle-mile facilities.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s High Cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Line 1120 – Confirm No Terrestrial Backhaul Options: Mark this “box” to denote your company has no terrestrial backhaul options within the supported area pursuant to § 54.313(g).

Line 1130 – Confirm Broadband Service Offering: Mark this “box” to denote your company

offers broadband service of at least 1 Mbps downstream and 256 kbps upstream within the supported area pursuant to § 54.313(g).

Annual Reporting for All Recipients of Lifeline Support – Lifeline Plans Terms and Conditions (1200)

Filing Regulations: 47 C.F.R. §54.422(a)(2)

Purpose: ETCs must provide information describing the terms and conditions of any voice telephony service plans offered to Lifeline subscribers.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. A separate form should be used for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s High Cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period associated with data filed in the following reporting.

{Note: Options for provisioning the Terms and Conditions of Voice Telephony Lifeline: ETCs have the option to provide this summary information of their lifeline plan by either attaching a document at line 1210 or entering a website address at line 1220. Whichever option is selected, the response must detail the terms and conditions of any voice telephony service plans offered to Lifeline subscribers, including details on the number of minutes provided as part of all Lifeline plans offered, additional charges, if any, for toll calls, and rates for each such plan.}

Line 1210 – Terms and Conditions of Voice Telephony Lifeline: If you elect to provide your Lifeline plan data in PDF form, please attach a document which details the terms and conditions of any voice telephony service plans, generally available to the public, offered to Lifeline subscribers.

Line 1220 – Link to Website: If you elect to provide your Lifeline plan data through a website link, please provide the public website which details the terms and conditions of any voice telephony service plans, which has been made generally available to the public, offered to Lifeline subscribers.

Line 1221 – Information Describing Terms and Conditions: Please check this box to confirm that the attached PDF, on line 1210, or the website address, on line 1220, contains an explanation of the terms and conditions of any voice telephony service plans offered to Lifeline subscribers.

Line 1222 – Number of Minutes Provided: Please check this box to confirm that the attached PDF, on line 1210, or the website address, on line 1220, contains an explanation of the number of minutes provided as part of all plans offered to Lifeline subscribers.

Line 1223 – Additional Charges: Please check this box to confirm that the attached PDF, on line 1210, or the website address, on line 1220, contains an explanation of the additional charges, if any, for toll calls, and rates as part of all plans offered to Lifeline subscribers.

Annual Reporting by Price Cap Carriers Additional Documentation(2005)

Filing Regulations: 47 C.F.R. §54.313(b),(c),(d),(e)

Purpose: Consolidates your ETC’s information and certifications as a recipient of incremental Connect America Fund Phase I support, frozen high-cost support, Connect America ICC support, and Connect America Fund Phase II support.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are a ETC and do not know your SAC, please contact USAC’s High Cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Line 2010 – Incremental Connect America Fund Phase I Reporting (2^nd Year Certification): Any ETC which receives incremental Connect America Fund Phase I support pursuant to 47 C.F.R. § 54.312(b) must mark this “box” to certify it has deployed broadband service to no fewer than two-thirds of the required locations. This certification must be filed in the ETC’s annual report two years after it accepts funding (pursuant to 47 C.F.R. § 54.312(b)) as required by 47 C.F.R. §54.313(b)(1).

Line 2011 – Incremental Connect America Fund Phase I Reporting (3^rd Year Certification): Any ETC which receives incremental Connect America Fund Phase I support pursuant to 47 C.F.R. § 54.312(b) must mark this “box” to certify it has deployed broadband service to all the required locations. This certification must be filed in the ETC’s annual report three years after it accepts funding (pursuant to 47 C.F.R. § 54.312(b)) as required by 47 C.F.R. § 54.313(b)(1). Further, ETCs must certify they have deployed broadband service in compliance with the functionality requirements in 47 C.F.R. § 54.313(b)(2).

Line 2012 – Price Cap Carrier Frozen Support Certification (2013 Use of Frozen Support Certification): Any ETC receiving frozen high-cost support pursuant to 47 C.F.R. § 54.312(a) must mark this “box” to certify it has used the support received in 2012 to achieve the goal of universal availability of voice and broadband in this study area. This certification must be filed by July 1, 2013, as required by 47 C.F.R. § 54.313(c)(1).

Line 2013 – Price Cap Carrier Frozen Support Certification (2014 Use of Frozen Support Certification): Any ETC receiving frozen high-cost support pursuant to 47 C.F.R.§ 54.312(a) must mark this “box” to certify one-third of the support received in 2013 was used to build and operate broadband-capable networks to offer broadband in areas substantially unserved by an unsubsidized competitor. For purposes of complying with this requirement, the ETC must certify that at least 50% of the locations served are in census blocks shown as unserved on the National Broadband Map. This certification must be filed by July 1, 2014, as required by 47 C.F.R. § 54.313(c)(2).

Line 2014 – Price Cap Carrier Frozen Support Certification (2015 Use of Frozen Support Certification): Any ETC receiving frozen high-cost support pursuant to 47 C.F.R. § 54.312(a) must mark this “box” to certify two-thirds of the support received in 2014 was used to build and operate broadband-capable networks to offer broadband in areas substantially unserved by an unsubsidized competitor. For purposes of complying with this requirement, the ETC must certify that at least 50% of the locations served are in census blocks shown as unserved on the National Broadband Map. This certification must be filed by July 1, 2015, as required by 47 C.F.R. § 54.313(c)(3).

Line 2015 – Price Cap Carrier Frozen Support Certification (2016 Use of Frozen Support Certification and future periods): Any ETC receiving frozen high-cost support pursuant to 47 C.F.R. § 54.312(a) must mark this “box” to certify all of the support received in 2015 and subsequent years was used to build and operate broadband-capable networks to offer broadband in areas substantially unserved by an unsubsidized competitor. For purposes of complying with this requirement, the ETC must certify that at least 50% of the locations served are in census blocks shown as unserved on the National Broadband Map. This certification must be filed by July 1, 2016 (and future periods) as required by 47 C.F.R. § 54.313(c)(4).

Line 2016 – Price Cap Carrier Connect America Fund ICC Support Certification (Certification Support Used to Build Broadband): Any ETC receiving high-cost support to offset access charges pursuant to 47 C.F.R. § 54.304 must mark this “box” to certify all of the support received was used to build and operate broadband-capable networks to offer broadband in areas substantially unserved by an unsubsidized competitor. For purposes of complying with this requirement, the ETC must certify that at least 50% of the locations served are in census blocks shown as unserved on the National Broadband Map. This certification must be filed by July 1, 2013 (and future periods) as required by 47 C.F.R. § 54.313(d).

Line 2017 – Connect America Phase II Reporting (3^rd year Broadband Service Certification): Any ETC receiving Connect America Phase II support must mark this “box” to certify it is providing broadband service to 85% of its supported locations at actual speeds of at least 4 Mbps downstream/1 Mbps upstream, with latency suitable for real-time applications, including Voice over Internet Protocol, and usage capacity that is reasonably comparable to reasonably comparable offerings in urban areas. This certification must be filed by July 1 of the third year following implementation of Connect America Phase II.

Line 2018 – Connect America Phase II Reporting (5^th year Broadband Service Certification): Any ETC receiving Connect America Phase II support must mark this “box” to certify it is providing broadband service to 100% of its supported locations at actual speeds of at least 4 Mbps downstream/1 Mbps upstream, and a percentage of supported locations, as specified by the Wireline Competition Bureau, at actual speeds of 6 Mbps downstream/1.5 Mbps upstream, with latency suitable for real-time applications, including Voice over Internet Protocol, and usage capacity that is reasonably comparable to reasonably comparable offerings in urban areas. This certification must be filed by July 1 of the fifth year following implementation of Connect America Phase II.

Line 2019 – Interim Progress Certification: Any ETC receiving Connect America Phase II support must mark this “box” to certify the filing of an annual progress report on its five-year service quality plan filed pursuant to 47 C.F.R. § 54.202(a). In addition, this report must include certifications that the ETC is reaching the interim deployment milestones and has taken reasonable steps to meet broadband functionality targets for all supported locations at the expiration of the five-year term for Connect America Phase II funding. These certifications must be filed annually by July 1st as required by 47 C.F.R. § 54.313(e)(3)(i).

Line 2020 – Data on Community Anchor Institutions: Please check this box to confirm that the attached PDF, on line 2021, contains the required information pursuant to 47 C.F.R. § 54.313 (e)(3)(ii), to provide the number, names, and addresses of community anchor institutions to which the ETC began offering broadband service in the preceding calendar year.

Line 2021 – Interim Progress Community Anchor Institutions: Any ETC receiving Connect America Phase II support must file an annual progress report on its five-year service quality plan filed pursuant to 47 C.F.R. § 54.202(a). Please attach a PDF containing a list of the number, names, and addresses of community anchor institutions to which the ETC newly deployed broadband service in the preceding calendar year. This report must be filed annually by July 1st as required by 47 C.F.R. § 54.313(e)(ii).

Annual Reporting by Rate-of-Return Carriers Additional Documentation (3005)

Filing Regulations: 47 C.F.R. §54.313(f)

Purpose: Consolidates the ETC’s information and certifications as a recipient of high-cost support and high-cost support to offset access charge reductions.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s High Cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Line 3010 – Milestone Certification: Any ETC receiving support must file a progress report on its five-year service quality plan filed pursuant to 47 C.F.R. § 54.202(a). The ETC must certify it has taken reasonable steps to provide upon reasonable request broadband service at actual speeds of 4 Mbps downstream/1 Mbps upstream, with latency suitable for real-time applications, including Voice over Internet Protocol, and usage capacity that is reasonably comparable to reasonably comparable offerings in urban areas, and that requests for such service are met within a reasonable amount of time. This certification must be filed by July 1, 2014 (and future periods) as required by 47 C.F.R. §54.313(f)(1)(i).

Line 3011 – Data on Community Anchor Institutions: Please check this box to confirm that the attached PDF, on line 3012, contains the required information pursuant to § 54.313 (f)(1)(ii), to provide the number, names, and addresses of community anchor institutions to which the ETC began offering broadband service in the preceding calendar year.

Line 3012 – Community Anchor Institutions: Any ETC receiving support must file a progress report on its five-year service quality plan filed pursuant to 47 C.F.R.§ 54.202(a). This report must include a list of the number, names, and addresses of community anchor institutions to which the ETC newly deployed broadband service in the preceding calendar year. This must be filed annually by July 1st as required by 47 C.F.R. §54.313(f)(1)(ii).

Annual Report of Privately Held Rate-of-Return Carriers: Any privately held rate-of-return ETC must file a full and complete annual report of the company’s financial condition and operations as of the end of the preceding fiscal year. This annual report must be filed by July 1, 2013, and each year thereafter and contain all required reporting as required in 47 C.F.R. § 54.313(f)(2).

Line 3013 – Qualify as a Privately Held Rate-of-Return Carriers: Respond whether your company, as defined in section 54.313(f)(2), qualifies as a privately held rate-of-return carrier who will be required to file financial reports beginning in July 1, 2013, and annually thereafter.

Line 3014 – Privately Held Rate-of-Return Carrier Who Files Annual RUS Reports: If your company responded in the affirmative on line 3013, then respond whether your company is a privately held rate-of-return carrier receiving loans from the Rural Utilities Service (RUS) and annually files electronic copies of their annual RUS reports (Operating Report for Telecommunications Borrowers).

Line 3015: Please check this box to confirm that the attached PDF, on line 3017, contains an electronic copy of your annual RUS reports (Operating Report for Telecommunications Borrowers).

Line 3016: Please check this box to confirm that the attached PDF, on line 3017, contains a Balance Sheet, Income Statement and Statement of Cash Flows.

Line 3017 – Privately Held Rate-of-Return Carrier’s Annual RUS Reports: If your company responded in the affirmative on line 3014, then attach an electronic copy of your annual RUS reports (Operating Report for Telecommunications Borrowers).

Line 3018 – Privately Held Rate-of-Return Carrier Who Files Annual RUS Reports: If your company responded in the negative on line 3014 and your company is a privately held rate-of-return carriers that is not receiving loans from the RUS, then respond whether your company’s financial statements are audited.

If your company’s financial statements are audited in the ordinary course of business your company must attach either:

(1) a copy of your audited financial statement; or

(2) a financial report in a format comparable to RUS Operating Report for Telecommunications Borrowers, accompanied by a copy of a management letter issued by the independent certified public accountant that performed the company’s financial audit.

If your company’s financial statements are not audited in the ordinary course of business, you company must attach either:

(1) a copy of your financial statement which has been subject to review by an independent certified public accountant; or

(2) a financial report in a format comparable to RUS Operating Report for Telecommunications Borrowers, with the underlying information subjected to a review by an independent certified public accountant and accompanied by an officer certification that: (a) the carrier was not audited in the ordinary course of business for the preceding fiscal year; and (b) that the reported data are accurate.

If your company’s response is in the affirmative on line 3018:

Line 3019 – Please check this box to confirm your submission, on line 3026 pursuant to § 54.313(f)(2), contains a copy of their audited financial statement; or a financial report in a format comparable to RUS Operating Report for Telecommunications Borrowers{see attached worksheets}.

Line 3020 – Please check this box to confirm your submission, on line 3026 pursuant to § 54.313(f)(2), contains a Balance Sheet, Income Statement and Statement of Cash Flows.

Line 3021 – Please check this box to confirm your submission, on line 3026 pursuant to § 54.313(f)(2), contains a copy of a management letter issued by the independent certified public accountant that performed the company’s financial audit.

If your company’s response is in the negative on line 3018:

Line 3022 – Please check this box to confirm your submission, on line 3026 pursuant to § 54.313(f)(2), contains a copy of your financial statement which has been subject to review by an independent certified public accountant; or 2) a financial report in a format comparable to RUS Operating Report for Telecommunications Borrowers {see attached surrogate financial statements 3005a, 3005b, 3005c to be utilized}.

Line 3023 – Please check this box to confirm your submission, on line 3026 pursuant to § 54.313(f)(2), contains the underlying information subjected to a review by an independent certified public accountant.

Line 3024 – Please check this box to confirm your submission, on line 3026 pursuant to § 54.313(f)(2), contains the underlying information subjected to an officer certification.

Line 3025 – Please check this box to confirm your submission, on line 3026 pursuant to § 54.313(f)(2), contains a Balance Sheet, Income Statement and Statement of Cash Flows.

Line 3026 – Privately Held ROR Non-RUS Filing: If your company is a privately held rate-of-return carrier that is not receiving loans from the RUS, then attach a worksheet which is compliant with the requirements of § 54.313(f)(2).

Certification – Reporting Carrier

Filing Regulations: 47 C.F.R. §54.313

Purpose: ETCs filing §54.313 and/or §54.422 annual reporting, must have a company officer complete this certification to attest to the validity of all information reported in Form 481. As an ETC, you may choose to complete this filing directly and submit it to the FCC, USAC, and the relevant state commissions, relevant authority in a U.S. Territory, or Tribal governments, as appropriate.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s High-cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Certification to be completed by a reporting carrier, if the carrier is filing annual reporting on its own behalf.

Name of Reporting Carrier: Provide the reporting carrier identification of the Study Area contained in this Form 481 filing.
Signature of Authorized Officer: Provide the signature of the reporting carrier’s appropriate officer attesting to this Form 481 filing.
Date: Provide the date the reporting carrier’s appropriate officer executed this certification for this Form 481 filing.
Printed name of Authorized Officer: Provide the name of the reporting carrier’s appropriate officer who executed this certification for this Form 481 filing.
Title or position of Authorized Officer: Provide the title of the reporting carrier’s appropriate officer who executed this certification for this Form 481 filing.
Telephone number of Authorized Officer: Provide the telephone number of the reporting carrier’s appropriate officer who executed this certification for this Form 481 filing.
Study Area Code of Reporting Carrier: Provide the SAC identification code of the Study Area contained in this Form 481 filing.(same as line 010).

Certification – Agent / Carrier

Filing Regulations: 47 C.F.R. §54.313

Purpose: For ETCs filing §54.313 and/or §54.422 annual reporting, who elect to designate an agent to execute the compliance filing on your behalf and submit it to the FCC, USAC, and the relevant state commissions, relevant authority in a U.S. Territory, or Tribal governments, as appropriate. If an agent completes the FCC Form 481, an authorized officer of your company must advise USAC of the identity of your agent, and certify that the actual data provided to your authorized agent is accurate to the best of his/her knowledge.

Line 010 – Study Area Code (SAC): USAC assigns ETCs a SAC for each jurisdiction served. Please be sure to file a separate form for each study area in which you serve. If you are an ETC and do not know your SAC, please contact USAC’s High-cost Customer Service Center at 1-877-877-4925 for assistance.

Line 015 – Study Area Name: Provide the standard name used to identify your study area. Typically, the name is the same as your company name.

Line 020 – Program Year: The time period (prior calendar year) associated with data filed in the following reporting.

Certification of an officer to authorize an agent to file annual reports on behalf of the reporting carrier

Name of the Authorized Agent: Provide the name of the designated agent who will be executing the compliance filing on the reporting carrier’s behalf.
Name of Reporting Carrier: Provide the reporting carrier identification of the Study Area contained in this Form 481 filing.
Signature of Authorized Officer: Provide the signature of the reporting carrier’s appropriate officer attesting to this Form 481 filing.
Date : Provide the date the reporting carrier’s appropriate officer executed this certification for this Form 481 filing.
Printed name of Authorized Officer: Provide the name of the reporting carrier’s appropriate officer who executed this certification for this Form 481 filing.
Title or position of Authorized Officer: Provide the title of the reporting carrier’s appropriate officer who executed this certification for this Form 481 filing.
Telephone number of Authorized Officer: Provide the telephone number of the reporting carrier’s appropriate officer who executed this certification for this Form 481 filing.
Study Area Code of Reporting Carrier: Provide the SAC identification code of the Study Area contained in this Form 481 filing.(same as line 010).

Certification of agent authorized to file annual reports on behalf of the reporting carrier

Name of Reporting Carrier: Provide the reporting carrier identification of the Study Area contained in this Form 481 filing.
Name of the Authorized Agent or Employee of Agent: Provide the name of the designated agent, or their employee, who will be completed the compliance filing on the reporting carrier’s behalf.
Signature of Authorized Agent or Employee of Agent: Provide the signature of designated agent, or their employee, who completed this Form 481 filing on the reporting carrier’s behalf.
Date : Provide the date the designated agent, or their employee executed this certification for this Form 481 filing.
Printed name of Authorized Agent or Employee of Agent: Provide the name of the reporting carrier’s designated agent, or their employee who executed this certification for this Form 481 filing.
Title or position of Authorized Agent or Employee of Agent: Provide the title of the reporting carrier’s designated agent, or their employee who executed this certification for this Form 481 filing.
Telephone number of Authorized Agent or Employee of Agent: Provide the telephone number of the reporting carrier’s designated agent, or their employee who executed this certification for this Form 481 filing.
Study Area Code of Reporting Carrier: Provide the SAC identification code of the Study Area contained in this Form 481 filing.(same as line 010).

1 See Connect America Fund et al., WC Docket Nos. 10-90, et al., Report and Order and Further Notice of Proposed Rulemaking, 26 FCC Rcd 17663 (2011) (USF/ICC Transformation Order) (adopting section 54.313 of the Commission’s rules).

2 See Lifeline and Link Up Reform and Modernization et al., WC Docket No.11-42, et al., Report and Order and Further Notice of Proposed Rulemaking, 27 FCC Rcd 6656 (2012) (Lifeline Reform Order) (adopting section 54.422 of the Commission’s rules).

3 See USF/ICC Transformation Order, 26 FCC Rcd at 17853, para. 581.

4 See 47 C.F.R. § 54.313.

5 47 C.F.R. § 54.313(k). Recipients that solely receive support from the Phase I Mobility Fund are subject to the reporting requirements in section 54.1009, which is collected pursuant to a different OMB-approved information collection.

6 47 C.F.R. § 54.313(j); see also Connect America Fund et al., WC Docket No. 10-90 et al., Third Order on Reconsideration, 27 FCC Rcd 5622, 5626, para. 10 (2012) (Third Reconsideration Order) (revising the filing deadline to July 1).

7 47 C.F.R. § 54.313(i).

8 See USF/ICC Transformation Order, 26 FCC Rcd at 17854, para. 587; see also Connect America Fund et al., WC Docket No. 10-90 et al., Order, 28 FCC Rcd 2051, 2054-55, para. 8 (Wireline Comp. Bur. 2013) (ETC Reporting Clarification Order).

9 47 C.F.R. § 54.313(a)(1).

10 See USF/ICC Transformation Order, 26 FCC Rcd at 17853, para. 583; Third Reconsideration Order, 27 FCC Rcd at 5625, para. 8; ETC Reporting Clarification Order, 28 FCC Rcd at 2053-54, para. 7.

11 47 C.F.R. § 54.313(a)(2) through (a)(4).

12 47 C.F.R. § 54.313(a) (requiring ETCs to separately break out for voice and broadband information and data required in section 54.313(a)(1) through (a)(7)); see also ETC Reporting Clarification Order, 28 FCC Rcd at 2056, para. 14 (revising section 54.313).

13 See The Proposed Extension of Part 4 of the Commission’s Rules Regarding Outage Reporting To Interconnected Voice Over Internet Protocol Service Providers and Broadband Internet Service Providers, PS Docket No. 11-82, Report and Order, 27 FCC Rcd 2650 (2012) (deferring action on possible performance degradation thresholds for measuring an outage of broadband Internet service).

14 47 C.F.R. § 54.313(a)(5), (6); see also 47 C.F.R. § 54.202(a)(2).

15 47 C.F.R. § 54.313(a) (requiring ETCs to separately break out for voice and broadband information and data required in section 54.313(a)(1) through (a)(7)); see also ETC Reporting Clarification Order, 28 FCC Rcd at 2056, para. 14 (revising section 54.313).

16 47 C.F.R. § 54.313(a)(7).

17 47 C.F.R. § 54.313(a)(8).

18 47 C.F.R. § 54.313(a)(9); see also Office of Native Affairs and Policy, Wireless Telecommunications Bureau, and Wireline Telecommunications Bureau Issue Further Guidance on Tribal Government Engagement Obligation Provisions of the Connect America Fund, WC Docket Nos. 10-90 et al., 27 FCC Rcd 8176 (2012).

19 47 C.F.R. § 54.313(a)(10).

20 47 C.F.R. § 54.313(a)(11).

21 47 C.F.R. § 54.313(b); see also 47 C.F.R. § 54.312(b).

22 47 C.F.R. § 54.313(c); see also 47 C.F.R. § 54.312(a).

23 47 C.F.R. § 54.313(d); see also 47 C.F.R. § 54.304; USF/ICC Transformation Order, 26 FCC Rcd at 17994-95, para. 918.

24 47 C.F.R. § 54.313(e).

25 47 C.F.R. § 54.313(f).

26 47 C.F.R. § 54.313(f)(2); see also Connect America Fund et al., WC Docket No. 10-90 et al., Fifth Order on Reconsideration, 27 FCC Rcd 14549, paras. 6-11 (2012) (Fifth Reconsideration Order) (revising financial reporting requirement for privately held rate-of-return carriers).

27 47 C.F.R. § 54.313(h); see also Connect America Fund et al., WC Docket No. 10-90 et al., Third Order on Reconsideration, 27 FCC Rcd 5622, 5629-31, paras. 18-22 (2012) (Third Reconsideration Order) (revising the filing deadline for rates, permitting mid-year updates, and clarifying how carriers should calculate rates).

28 47 C.F.R. § 54.422.

29 47 C.F.R. § 54.422(c).

30 47 C.F.R. § 54.422(a)(1).

31 47 C.F.R. § 54.422(a)(2).

32 47 C.F.R. § 54.422(b). ETCs that receive both high-cost support and low-income support report this information pursuant to section 54.313.

33 47 C.F.R. § 0.459. In the Fifth Reconsideration Order, the Commission permitted privately-held rate of return carriers to seek confidential treatment of their financial information filed pursuant to section 54.313(f)(2). See Fifth Reconsideration Order, 27 FCC Rcd at 14555-56, para. 17; Connect America Fund et al., WC Docket No. 10-90 et al., Protective Order, 27 FCC Rcd 14231 (Wireline Comp. Bur. 2012) (Protective Order).

34 47 C.F.R. § 54.202 (a)(1)(ii) specifies that recipients should “[s]ubmit a five-year plan that describes with specificity proposed improvements or upgrades to the applicant's network throughout its proposed service area.”

35 47 C.F.R. § 54.313(a)(1) specifies that recipients should submit “[a] progress report on its five-year service quality improvement plan pursuant to § 54.202(a), including maps detailing its progress towards meeting its plan targets, an explanation of how much universal service support was received and how it was used to improve service quality, coverage, or capacity, and an explanation regarding any network improvement targets that have not been fulfilled in the prior calendar year. The information shall be submitted at the wire center level or census block as appropriate.”

36 47 C.F.R. § 54.318(e); Connect America Fund et al., WC Docket Nos. 10-90, et al., Report and Order and Further Notice of Proposed Rulemaking, 26 FCC Rcd 17663, 17751 para. 238 (2011).

37 Id.

38 Id.

39 47 C.F.R. § 54.313(a)(9); see also Office of Native Affairs and Policy, Wireless Telecommunications Bureau, and Wireline Telecommunications Bureau Issue Further Guidance on Tribal Government Engagement Obligation Provisions of the Connect America Fund, WC Docket Nos. 10-90 et al., 27 FCC Rcd 8176 (2012).

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File Type	application/msword
File Title	FCC Form 54
Author	rbinder
Last Modified By	judith
File Modified	2013-07-25
File Created	2013-07-25