FCC 508 Projected Connect America Fund Broadband Loop Support

Connect America Fund - Broadband Loop Support (CAF-BLS)

Copy of 508 Form_revised_0713.xlsx

Connect America Fund - Broadband Loop Support

OMB: 3060-0986

Document [xlsx]
Download: xlsx | pdf

Overview

PROJ. CAF BLS.
508 CERT.-REPORTING CARRIER
508 CERTIFICATION-AGENT
508 NOTICE


Sheet 1: PROJ. CAF BLS.

PROJECTED CONNECT AMERICA FUND-BROADBAND LOOP SUPPORT
Block 1 - Contact Information
ROW # DATA ELEMENT FORMAT OF REQUESTED DATA RESPONSE
1 Carrier Study Area Code 6 numeric digits
2 Carrier Study Area Name alpha characters
3 Service Provider Identification Number 9 numeric digits
4 Data Period (specify years) 07/01/20yy - 06/30/20yy
5 Date of Submission mm/dd/yyyy
6 Contact Name alpha characters
7 Contact Telephone Number [including area code] 10 numeric digits
8 Contact E-mail Address alpha/numeric characters
Block 2 - Projected CAF-BLS by Study Area
9 Projected Common Line Revenue Requirement (July 1-June 30) amount in $
10 Projected Consumer Broadband-Only Revenue Requirement (July 1- June 30) amount in $
11 Projected SLC Revenues (July 1-June 30) amount in $
12a Forcecasted Average Monthly Consumer Broadband-only Loops numeric digits
12b Imputed Consumer Broadband-only Revenues
(Forecasted Average Monthly Consumer Broadband-only Loops * 12 * $42)
amount in $
12 Projected Consumer Broadband-Only Loop Revenues (July 1- June 30) amount in $
13 Projected Special Access Surcharges (July 1-June 30) amount in $
14 Projected Line Port Costs in Excess of Basic Analog Service (July 1-June 30) amount in $

Sheet 2: 508 CERT.-REPORTING CARRIER

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING FCC FORM 508 ON ITS OWN BEHALF:


























































Certification of Officer or Employee as to the Accuracy of the Data Reported in FCC Form 508, Connect America Fund-Broadband Loop Support Mechanism Projected CAF-BLS Form, on Behalf of Reporting Carrier














































Name of Reporting Carrier
Signature of authorized officer or employee Date
Printed name of authorized officer or employee
Title or position of authorized officer or employee
Email address of authorized officer or employee
Telephone number of authorized officer or employee: ( _ _ _ ) _ _ _ - _ _ _ _, ext. _ _ _ _ _
Study Area Code of Reporting Carrier

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





Sheet 3: 508 CERTIFICATION-AGENT

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING FCC FORM 508 ON THE CARRIER'S BEHALF:













































Certification of Officer or Employee to Authorize an Agent to File FCC Form 508, Connect America Fund-Broadband Loop Support Mechanism Projected CAF-BLS Form, on Behalf of Reporting Carrier
















Name of Authorized Agent
Name of Reporting Carrier
Signature of authorized officer or employee Date
Printed name of authorized officer or employee
Email address of authorized officer or employee
Title or position of authorized officer or employee
Telephone number of authorized officer or employee: ( _ _ _ ) _ _ _ - _ _ _ _, ext. _ _ _ _ _
Study Area Code of Reporting Carrier

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


TO BE COMPLETED BY THE AUTHORIZED AGENT:













































Certification of Agent Authorized to File FCC Form 508, Connect America Fund-Broadband Loop Support Mechanism Projected CAF-BLS Form, on Behalf of Reporting Carrier
















Name of Reporting Carrier
Name of Authorized Agent
Signature of authorized agent or employee of agent Date
Printed name of authorized agent or employee of agent
Email address of authorized agent or employee agent
Title or position of authorized agent or employee of agent
Telephone number of authorized agent: ( _ _ _ ) _ _ _ - _ _ _ _, ext. _ _ _ _ _
Study Area Code of Reporting Carrier

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



Sheet 4: 508 NOTICE

















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