FCC 507 Line Count Data Collection

Part 54 – High Cost Loop Support Reporting to National Exchange Carrier Association (NECA)

Copy of 507 Form_revised_080317.xlsx

Part 54 – High Cost Loop Support Reporting to National Exchange Carrier Association (NECA)

OMB: 3060-0233

Document [xlsx]
Download: xlsx | pdf

Overview

LINE COUNT REPORT
CERTIFICATION-REPORTING CARRIER
CERTIFICATION-AGENT
NOTICE


Sheet 1: LINE COUNT REPORT

LINE COUNT DATA COLLECTION
Block 1 - Contact Information
ROW # DATA ELEMENT FORMAT OF REQUESTED DATA RESPONSE NO. OF ACQUIRED LINES
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 As Of mm/dd/yyyy

5 Contact Name alpha characters

6 Contact Telephone Number [including area code] 10 numeric digits


7 Contact Email address alpha/numeric characters

Block 2 - Line Counts
8 Residential and Single-Line Business Access Lines in Service numeric digits

9 Multi-Line Business Access Lines in Service numeric digits

10 Consumer Broadband-Only Lines in Service numeric digits

11 Total Number of Lines in Service in Study Area numeric digits

12 Name of Carrier From Which Lines Were Acquired, If Applicable alpha characters

13 Study Area Code From Which Lines Were Acquired, If Applicable 6 numeric digits

Sheet 2: CERTIFICATION-REPORTING CARRIER

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING FCC FORM 507 ON ITS OWN BEHALF:


























































Certification of Officer or Employee as to the Accuracy of the Data Reported in FCC Form 507, Line Count Report for Connect America Fund-Broadband Loop Support Mechanism, 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: CERTIFICATION-AGENT

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING FCC FORM 507 ON THE CARRIER'S BEHALF:













































Certification of Officer or Employee to Authorize an Agent to File FCC Form 507, Line Count Report for Connect America Fund-Broadband Loop Support Mechanism, 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)



TO BE COMPLETED BY THE AUTHORIZED AGENT:













































Certification of Agent Authorized to File FCC Form 507, Line Count Report for Connect America Fund-Broadband Loop Support Mechanism, on Behalf of Reporting Carrier
















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

Filing Due Date for this form (mmddyyyy)



Sheet 4: NOTICE





























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