Fcc 507 Line Count Data Collection

---

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