Participant Input and Feedback to Improve Functionality and Design of ELAP Module

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

ELAPtemplateforParticipants 3060-1149 final

Participant Input and Feedback to Improve Functionality and Design of ELAP Module

OMB: 3060-1149

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OMB 3060-1149


High Cost Universal Service

Information to be Submitted to Online Eligible Locations Adjustment Process (ELAP) Portal

(Note: This is a representative description of the information to be collected via the online portal and is not intended to be a visual representation of what each applicant will see).

Participant Information

Item Number

Field Description

Purpose/Instructions

1

Participant Name

This is the name of the authorized support recipient participating in this process. May be autogenerated by system.

2

Participant Address

This is the physical and mailing address of the participating support recipient to be used for service and notice purposes.

2

Data Contact Name(s)

Name(s) of the person(s) who prepared the submitted data

3

Data Contact Phone Number(s)

Phone number(s) of Data Contact Name(s)

4

Data Contact Phone Number(s) extension

Phone number extension, if any, of Data Contact Name(s)

5

Data Contact E-mail address(es)

Email address(es) of Data Contact Name(s)

6

Study Area Code(s)

Study Area code(s) applicable to data filed.

7

State

The state or states for which the carrier is making a filing.

8

Location ID

A number that uniquely identifies a reported location in the study area. Automatically generated by the system.

9

Census Block Code

The census block code of the location. Autogenerated by system based on submitted latitude/longitude of location.

10

Latitude of Location

Latitude of the reported location.

11

Longitude of Location

Longitude of reported location.

12

Location Address – Number & Street

Number and street address of the location.

13

Location Address-City

City associated with the street address of the location

14

Location Address-State

2 letter postal code abbreviation of the state associated with the street address of the location.

15

Location Address-Zip Code

5-digit ZIP code associated with the street address of the location

16

Location Address-No Postal Address Available

In those cases where postal address is not available, alternate address information

17

Number of units

If the location is a building with multiple units, such as an apartment or office building, the number units at that location.

18

GPS Method

Identifies primary method (i.e., field research, computer-based geolocation, or automated address geolocation) used to geolocate reported location

19

GPS Method as of Date

Date that field research or underlying research for computer-based or automated address geolocation was last confirmed as accurate

20

Location Type

Identifies reported location as qualifying location, prospective location, ineligible location.

21

Ineligible Reason Code

Identifies reason why specified location is marked ineligible, using preset drop- down list.

22

Ineligible Reason Comment

Further explanation if participant selects “other” as reason code for marking location as ineligible.

24

Methodology for Identifying Eligible Locations

Narrative description (pdf) of methodology or methodologies used to identify all eligible locations within the state

25

Supporting Evidence

Evidence supporting description of methodology and identification of locations, e.g., copies of (or links to) web-based photography, database pages, and/or public records information for a sample of randomly selected land units (e.g., parcels, plots).

23

Officer Certification

Officer certification that ELAP information is complete and accurate to the best of the officer’s knowledge and belief

24

Certifying Official Name

Name of certifying official.

25

Certifying Official Title

Job title of certifying official

26

Certifying Official Phone Number

Phone number of the certifying official

27

Certifying Official Phone Number, Extension

Phone number extension of the certifying official

28

Certifying Official Email Address

Email address of the certifying official

29

Date Signed

The date on which the filing is certified. Auto-generated








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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorJonathan Lechter
File Modified0000-00-00
File Created2021-01-13

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