Certification Form Legacy High-Cost Support Usage Flexibility Certification

Legacy High-Cost Support Usage Flexibility Certification
Pursuant to rules adopted by the Commission in the 5G Fund Report and Order (FCC 20-150), a competitive
eligible telecommunications carrier (ETC) that receives legacy high-cost support for mobile wireless services
must use an increasing percentage of such support on the deployment, maintenance, and operation of
mobile networks that provide 5G service. Each legacy support recipient must spend at least one-third of the
legacy support it receives in 2021, at least two-thirds of the legacy support it receives in 2022, and all legacy
support in 2023 and beyond on 5G.
A legacy support recipient has the flexibility to make up for any shortfall in meeting its 2021 requirement by
proportionally increasing the amount of support it spends above the two-thirds requirement for 2022,
provided that it certifies to the Wireline Competition Bureau the amount of support it will spend on 5G in
2021 and that it will make up for any 2021 shortfall in 2022.
For example, a competitive ETC that receives $9 million per year in legacy high-cost support is required to
spend at least $3 million in 2021, at least $6 million in 2022, and all $9 million in 2023 and each subsequent
year on 5G. If the competitive ETC only spends $2 million on 5G in 2021 ($1 million below the 2021
requirement), it must spend at least $7 million in 2022 on 5G ($1 million to complete the 2021 requirement,
plus $6 million for the 2022 requirement) and submit this certification to remain in compliance with its public
interest obligations.
Consistent with the geographic flexibility granted to legacy support recipients, a competitive ETC that
receives legacy support for multiple service areas or is affiliated with other competitive ETCs that receive
legacy support (for example, where such competitive ETCs share a common holding company) may submit a
single certification.
Completed certifications must be submitted via the Commission’s Electronic Comment Filing System in GN
Docket No. 20-32, available at https://www.fcc.gov/ecfs/.

Legacy High-Cost Support Information
Enter the service area(s) for which the competitive ETC and any affiliated mobile competitive ETC(s) receive
legacy high-cost support:
State

Study Area Code

Competitive ETC Name

Annual Legacy Support Amount

Total:
OMB Control Number 3060-XXXX
Estimated Average Burden Per Response: 1.75 hours

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Legacy High-Cost Support Usage Flexibility Certification
Enter the total amount of legacy high-cost support that the competitive ETC and/or its affiliates will spend on
the deployment, maintenance, and operation of mobile networks that provide 5G service in calendar year
2021 across the identified service areas:
Total Legacy High-Cost Support Usage to be Spent in 2021:

Certification
On behalf of the competitive ETC(s) identified above, I declare, under penalties of perjury, that:
1. I am an officer or other authorized representative of the competitive ETC(s) identified above;
2. I have read the information contained in this form and all information and statements contained
herein are true, correct, and complete;
3. In accordance with 47 CFR § 54.322(c)(4), the competitive ETC(s) identified above will make up for
any shortfall in the amount of legacy support required to be spent on 5G in calendar year 2021
pursuant to 47 CFR § 54.322(c)(1) by proportionally increasing the amount of legacy support spent on
5G in calendar year 2022 above the level required pursuant to 47 CFR § 54.322(c)(2); and
4. I understand that making willful false statements in any part of this certification is punishable by fine
or imprisonment pursuant to 47 U.S.C. §§ 416(c), 503(b)(1)(B), and 18 U.S.C. § 1001.
Name:
Phone:

Extension:

Email:
Title:
Signature:

Date:

NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT
We have estimated that each response to this collection of information will take 1.75 hours. Our estimate includes the
time to gather and compile the required information, and to certify and submit the information. 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, AMD-PERM, Paperwork Reduction Project (3060-XXXX), Washington, DC
20554. We will also accept your comments via the Internet if you send them to [email protected]. Please DO NOT SEND ANY
ACCESS REQUESTS OR SUBMIT ANY INFORMATION REQUIRED BY THIS COLLECTION 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 or if we fail to provide you
with this notice. This collection has been assigned an OMB control number of 3060-XXXX.
THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, OCTOBER 1, 1995,
44 U.S.C. 3507
OMB Control Number 3060-XXXX
Estimated Average Burden Per Response: 1.75 hours

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