FCC Form 560 Low Income Broadband Pilot Program Reporting Form

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

0819_FCC560_090412

FCC Form 560, Low Income Brodband Pilot Program Reporting Form

OMB: 3060-0819

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3060-0819

FCC Form 560

November 2012



LOW INCOME BROADBAND PILOT PROGRAM REPORTING FORM




PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS


The FCC is authorized under the Communications Act of 1934, as amended, to collect the information we request in this form. If we believe there may be a violation or a potential violation of a FCC statute, regulation, rule or order, your certification 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 certification may be disclosed to the Department of Justice or a court or adjudicative body when a) the FCC; or b) any employee of the FCC; or c) the United States Government is a party of a proceeding before the body or has an interest in the proceeding.


We have estimated that this collection of information will take .5 hours. Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, Office of Managing Director, AMD‑PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060‑0819). We will also accept your PRA comments if you send an e-mail to [email protected].

Please DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060‑0819.

THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31, 1974, 5 U.S.C. SECTION 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

COMPANY INFORMATION PROVIDED BY ETC WITH EACH SUBMISSION TO USAC

BLOCK A



Each ETC is required to submit the company specific information contained in block "Identifying Information - Block A" for each submission to USAC. All raw data that the ETC submits may be submitted as an Excel or CSV file.

Block A

Question

Response

Notes

Identifying Information

Service Provider Identification Number (SPIN)

 

 

Study Area Code(s) (SAC)

 

 

FCC Registration Number (FRN)

 

 

Legal Company Name and d/b/a

 

 

Company Mailing Address

 

 

Company Telephone Number

 

 

Company Fax number

 

 

Company Contact Email Address

 

 

Reporting Date

 

 

Company Contact Name

 

 

List of Project Code Identifiers in Pilot Project

 

Each variation of a proposed broadband service offering that an ETC offers in its project will be assigned a separate project code identifier by USAC (Project Code Identifier).



PROJECT-LEVEL INFORMATION PROVIDED BY ETC

BLOCK B



Each ETC is required to submit information contained in block "Broadband Service Offering Information - Block B" to USAC once, at the beginning of the ETC's project for each Project Code Identifier.

Block B

Question

Response

Notes

Broadband Service Offering Information

Project Code Identifier

 

Identifies the study group in terms of discount plans

List of geographic areas (e.g., census tract, wire center, study area) receiving this variation of the broadband service offering

 

Identifies relevant geographies being treated in study

Zip Codes receiving this variation of broadband service offering

 

List all zip codes fully or partially in this variation of broadband offering


PROJECT-LEVEL INFORMATION PROVIDED BY ETC

BLOCK C



Each ETC is required to submit information contained in block "Project Information - Block C," to USAC once, at the beginning of the ETC's project for each Project Code Identifier.


Block C

Question

Response

Notes

Project Information

Maximum number of months discount is available

0 - 12

Number of months discount is offered in study

Type of service offering

Bundled Voice & BB; Stand-alone BB

 

Technology used

Mobile, Fixed-wireless, Wireline (Telco or Cable), Other (indicate)

 

Broadband speed provided

specify upload and download speed

 Provide advertised speeds.

Monthly usage limit, if any

GB/month

If usage limits do not apply, respond with N/A.

If monthly usage limit applies, whether overage charges apply and if so, specify rate amount

$

If usage limits do not apply, respond with N/A. If overage charges do not apply, respond with N/A

If monthly usage limit applies with no overage charges, specify whether service is discontinued or broadband speed is reduced

Discontinued service, broadband speed is reduced, none of the above (specify)

If usage limits do not apply, respond with N/A. If overage charges apply for exceeding usage limits, respond with N/A.

Monthly broadband discount amount

$

 

Monthly cost to subscriber for broadband service after discount

$

 

Amount of discount provided to reduce or eliminate non-recurring fee(s), if any

$

 

Amount of non-recurring fees, if any, charged to subscriber after discount

$

 

Amount of discount for equipment provided to subscriber by ETC, if any

$

 If subscriber receives equipment at no cost, please include value of equipment given to subscriber

Cost to subscriber of equipment provided by ETC that is used for broadband after discount

$

 

Digital literacy training offered as part of broadband service offering

Yes/No

 


PROJECT-LEVEL INFORMATION PROVIDED BY ETC

BLOCK D







Each ETC is required to submit information contained in block "Aggregate Population Information for Variations of Broadband Service Offering - Block D" to USAC on a quarterly basis for each Project Code Identifier. If necessary provide a best estimate.


Block D

Question

Response

Notes

Aggregate Population Information for Variation of Broadband Service Offering

Project Code Identifier

 

Identifies the study group in terms of discount plans

Total number of Lifeline eligible subscribers in study population

 

Estimate if necessary, explaining your assumptions

Total number of eligible subscribers offered this variation of broadband service during the pilot

 

Estimate if necessary, explaining your assumptions

Total number of subscribers enrolled in the offered discount during the first month of the quarter



Total number of subscribers enrolled in the discount during the second month of the quarter

 

 

Total number of subscribers enrolled in the offered discount during the third month of the quarter



Total number of subscribers that have de-enrolled in the offered discount during the first month of the quarter



Total number of subscribers that have de-enrolled in the offered discount during the second month of the quarter



Total number of subscribers that have de-enrolled in the offered discount during third month of the quarter

 

 



SUBSCRIBER-LEVEL INFORMATION PROVIDED BY ETC

BLOCK E



Each ETC is required to submit the information contained in block "Enrollment Information - Block E" to USAC when all subscribers have enrolled in the ETC's project. Each subscriber must have a unique identifier, which will be used throughout the study, assigned by the ETC (Unique Subscriber Identifier).


Block E

Question

Response

Notes


Enrollment Information

Unique Subscriber Identifier

 

Unique, anonymized identifier assigned by ETC

Provided by ETC

Project Code Identifier

 

Identifies the subscriber's study group in terms of discount plan

Geographic Area

 

 

Zip code(s)

 

 

Date Subscribed

MM/DD/YY

 

Digital Literacy Program Offered?

Yes/No

 

Digital Literacy Offer Accepted at Enrollment?

Yes/No

Only enter if literacy program is offered to subscriber



SUBSCRIBER-LEVEL INFORMATION PROVIDED BY ETC

BLOCK F



Each ETC is required to submit the information contained in block "Follow-Up and Retention Information – Block F" based on subscriber records within three months after the subscriber received the last discount in the pilot. Each subscriber must have a unique identifier, which will be used throughout the study, assigned by the ETC (Unique Subscriber Identifier).



Block F

Question

Response

Notes


Follow-Up and Retention Information

Unique Subscriber Identifier

 

Unique, anonymized identifier assigned by the ETC

Provided by ETC

Project Code Identifier

 

Identifies the subscriber's study group in terms of discount plan

Did the subscriber participate in the study for the full duration of the program?

Yes/No

Number of months of discount actually received

0-12

 

If not currently subscribing, date service ended

MM/DD/YY

If customer ended service, indicate date ended

Did subscriber retain service with the ETC in the first month following the last discount (i.e. the first unsubsidized month)?

Yes/No

 

Did subscriber retain service with the ETC in the second month following the last discount (i.e. the second unsubsidized month)?

Yes/No


Did subscriber retain service with the ETC in the third month following the last discount (i.e. the third unsubsidized month)?

Yes/No



SUBSCRIBER-LEVEL INFORMATION COLLECTED FROM THE SUBSCRIBER

BLOCK G



Each ETC, or USAC if the ETC requests, is required to collect the information contained in block "Subscriber-Provided Information at Enrollment – Block G" directly from each subscriber prior to providing a discount and submit when all subscribers have enrolled in the project. ETCs have the option of having USAC collect this information through an electronic, online survey at enrollment; subscribers must consent to collection and sharing of this information in order to receive any discount. Each subscriber must have a unique identifier, which will be used throughout the study, assigned by the ETC (Unique Subscriber Identifier).

Block G

Question

Response

Notes



Subscriber-Provided Information at Enrollment

 

 

 

Collected from Subscriber


Unique Subscriber Identifier

 

Unique, anonymized identifier assigned by the ETC


Project Code Identifier

 

Identifies the subscriber's study group in terms of discount plan


Subscriber Age

 

 


Ages of household members




Number of household members using subsidized broadband

 

 


In 2011, what was this household's total income before taxes?

Less than $5,000, $5000-$9999

$10,000-$20,000, $20,001-$30,000, $30,001 or more,

Not Determined

 


Equipment expected to be used with broadband service - choose multiple

Desktop Computer, Laptop/netbook computer, Tablet, Mobile device (smartphone), mobile broadband modem (aircard)

 


Has this consumer subscribed to broadband in the past?

Never, Within last 3 months, Within last 6 months, Within last 12 months, More than 12 months ago

 


Reasons for not previously obtaining broadband - can choose more than one

Monthly cost too expensive, didn't use service, don't know how to use computer/Internet, uncomfortable with Internet (e.g. privacy concerns, dangerous for children), happy with dial-up, could access Internet elsewhere, other – specify

 


If subscriber previously subscribed to broadband, but dropped service, reason for dropping (can choose more than one response)

Monthly cost too expensive, didn't use service, the equipment no longer worked, don't know how to use computer/Internet, uncomfortable with Internet (e.g. privacy concerns, dangerous for children), happy with dial-up, could access Internet elsewhere

Answer NA if previous answer is "Never"


Reason(s) for use of Internet (can choose more than one response)

Want to stay in touch with family and friends, children need it for school, subscriber needs it for school, want to access music, movies and other entertainment, children want internet access, get health care or medical information, job required online access, need it for job searches, want to share photos or videos with family and friends, internet provider offered a good price for the service, use for daily activities (e.g. check bus schedule), other --- specify

 




SUBSCRIBER-LEVEL INFORMATION COLLECTED FROM THE SUBSCRIBER

BLOCK H



Each ETC, or USAC if the ETC requests, must collect the information contained in block “Follow-up and Subscriber Usage Information – Block H” from the subscriber no later than the end of the project. ETCs have the option of having USAC collect this information through an electronic, online survey; subscribers must consent to collection and sharing of this information in order to continue receiving any discounted broadband service. Each subscriber must have a unique identifier, which will be used throughout the study, assigned by the ETC (Unique Subscriber Identifier).




Block H

Question

Response

Notes



Follow-Up and Subscriber-Usage Information

Unique Subscriber Identifier

 

Unique, anonymized identifier assigned by the ETC

Collected from Subscriber


Project Code Identifier

 

Identifies the subscriber's study group in terms of discount plan


Number of Household members using discounted broadband service

 

 


Subscriber use of Internet (can choose more than one response)

Want to stay in touch with family and friends, children need it for school, subscriber needs it for school, want to access music, movies and other entertainment, children want internet access, job required online access, need it for job searches, want to share photos or videos with family and friends, internet provider offered a good price for the service, use for daily activities (paying bills), other --- specify



Did the subscriber participate or is currently participating in any training programs so he/she can better use a computer and the Internet?

No training class taken, currently taking a training class, completed a training class

 


Equipment used with service (can choose more than one response)

Desktop Computer, Laptop Computer (includes netbook), Tablet, Mobile Device (Smartphone)
Mobile Broadband Modem (aircard)








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File Typeapplication/msword
File TitleLow Income Broadband Pilot Program Reporting Form
AuthorGarnet.Hanly
Last Modified Byjudith
File Modified2012-09-04
File Created2012-09-04

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