Form FCC 471 FCC 471 Description of Services Requested and Certification Form

OMB Control No. 3060-0806 Estimated Time per Response

December 2018 4.5 hours

Schools and Libraries Universal Service

Description of Services Requested and Certification Form 471

(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. Where possible, information already provided by applicants from previous filing years or that was pre-filed in the system portal can be carried forward and auto-populated into the form. Also, where the system has the input to automatically generate calculations and other information for the form, it will provide that information).

#	Section	Field Description	Purpose/Instructions
1	Basic Information	Form Nickname	To create a unique identifier for this submission, the applicant simply enters a nickname (e.g., 2016 FY Applewood SD Form 471).
2	Basic Information	FCC Form 471 Application Number	Auto-generated by the system: This is a USAC-assigned unique identifier for this submission.
3	Basic Information	Applicant Name	This is the name of the organization submitting this form—school, school district, library (outlet/branch or system) or a consortium of those entities (schools, libraries, or schools and libraries). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
4	Basic Information	Funding Year	Auto-generated by the system based on the funding year of the next application window: This is the Funding Year for which service are sought.
5	Basic Information	Entity Number	Auto-generated by the system: This is the Unique identifier assigned by USAC to the organization listed in Applicant Name.
6	Basic Information	FCC Registration Number	This is the unique FCC identifier for the organization listed as the applicant. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
7	Basic Information	Mailing Address	This is the mailing address for the applicant. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
8	Basic Information	Telephone Number	This is the main telephone line for the applicant which may/may not be the same as the telephone number for the person who should be contacted with questions about this application. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
9	Basic Information	Type of Application	Options are: school, school district, library/library system, consortium, statewide consortium. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
10	Basic Information	Applicant Attributes	Attributes for a School or School District include: Public, Private, Charter and ESA. Attributes for a Library System include: Public and Private. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
11	Basic Information	Contact Person’s Name	Provide the name of the person who should be contacted with questions about this application. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
12	Basic Information	E-mail Address	E-mail Address of the Contact Person. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
13	Basic Information	Contact Person’s Telephone Number	Telephone Number of the Contact Person. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
14	Basic Information	Holiday/vacation/summer contact information	This line will collect name, phone number, and email of the holiday/vacation/summer contact.
15	Basic Information	Website	Website URL for school district, school or library. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
16	Basic Information	Consultant Information	System will ask for consultant name, registration number, consultant’s employer, street address and telephone number, and e-mail address. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
17	Entity Information & Discount Calculations	Entity Number	Unique identifier assigned by USAC to each school, library outlet/branch, or NIF.
18	Entity Information & Discount Calculations	Name of the Individual School, Library Outlet/Branch, or NIF name	If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
19	Entity Information & Discount Calculations	Physical Address	Physical address of each Individual School, Library Outlet/Branch, or NIF. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
20	Entity Information & Discount Calculations	National Center for Education Statistics (NCES) School ID or Federal-State Cooperative System (FSCS) Library ID	For each school, this line will collect the NCES School ID. For each library, this line will collect the FSCS Library ID. (This line is not applicable to NIFs.) This information will pre-populated into this submission by USAC, if available.
21	Entity Information & Discount Calculations	Urban or Rural	The system will automatically determine the Urban/Rural status of the entity based on the physical address associated with that entity. Entity can override and change status if necessary.
22	Entity Information & Discount Calculations	Non-Instructional Facility (NIF)	Indicates whether the entity is a NIF. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
23	Entity Information & Discount Calculations	State Local Education Agency (LEA) ID	State school IDs (LEA code and school code). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
24	Entity Information & Discount Calculations	State School ID	State school IDs (LEA code and school code). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
25	Entity Information & Discount Calculations	Endowment Amount (Dollars)	Schools will be asked if they have an endowment and the amount of their endowment. This is related to the certification they make that they are eligible because they are a school under the statutory definitions of elementary and secondary schools found in the No Child Left Behind Act of 2001, 20 U.S.C. §§ 7801(18) and (38), that do not operate as for-profit businesses and do not have endowments exceeding $50 million.
26	Entity Information & Discount Calculations	Maximum number of students on school premises at the same time	Collected for purposes of calculating the Category Two budget. This field is defined as the maximum number of students on the premise at the same time. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
27	Entity Information & Discount Calculations	Maximum student count based on estimate (Yes/No)	Indicate if the maximum number of students in the school is based on an estimate. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
28	Entity Information & Discount Calculations	Alternative Discount	Applicant will indicate if they used an alternative discount methodology, such as a survey. Applicant will also indicate whether it has adopted the Community Eligibility Program (CEP) and if so, provide the percentage of direct certification students. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
29	Entity Information & Discount Calculations	School Attributes:	The list of attributes for a School includes: Public, Private, Pre-K, Head Start, Adult Education, Juvenile Justice, Dormitory, Charter, Tribal, New Construction and Educational State Agency (ESA). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
30	Entity Information & Discount Calculations	Annex	Captures the following fields for an Annex: Name of Annex, Name of Associated School/Library, Entity Number for the Associated School/Library, Physical Address of the Annex, Square Feet (if a Library Annex), and Status (Values are: Active or Closed). If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
31	Entity Information & Discount Calculations	Total Square Footage of library outlet	Used to determine the Category Two budget for libraries. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
32	Entity Information & Discount Calculations	Main Branch? (Yes/No)	Used to determine the Category Two budget for libraries. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
33	Entity Information & Discount Calculations	School District Billed Entity Number	Used to determine the Category Two budget for libraries. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
34	Entity Information & Discount Calculations	Library Attributes	The list of attributes for a Library includes: Public, Private, Academic, Research, Tribal, Bookmobile, Kiosk, New Construction, Main Branch and State Library Agency. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
35	Entity Information & Discount Calculations	Institute of Museum and Library Services (IMLS) Locale Code	The IMLS assigns Locale Codes at the entity level (e.g., for each outlet/branch). Note that a library annex will have the same Locale Code as its associated outlet/branch. This is used to determine the budget for libraries located in cities and urbanized areas with a population of 250,000 or more, as identified by (IMLS) locale codes of 11, 12, and 21. There is a separate budget for urban libraries of $5.00 per square foot. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
36	Entity Information & Discount Calculations	Summary of Category Two Budget Information	Pre-discount Entity Category Two Budget; Post-discount Entity Category Two Budget. The system will calculate these amounts based on the information entered or pulled from the applicant’s profile.
37	Entity Information & Discount Calculations	Total Number of Students Enrolled in School District	Total number of students in the school district is used to determine the district-wide discount calculation and should include all of the students in the school district as a whole, counting each student only once. This is different than the student count for Category Two. If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission.
38	Entity Information & Discount Calculations	Percentage of Students in School District Eligible for NSLP	This is used to determine the school district’s discount rate.
39	Entity Information & Discount Calculations	Category One Discount Rate	System determines the discount rate that applies to Category One services. (Voice services will be subject to a separate discount rate). Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
40	Entity Information & Discount Calculations	Category Two Discount Rate	System determines the discount that applies to Category Two services.
41	Entity Information & Discount Calculations	Connectivity Questions	Provides data to USAC about sufficiency of Internet access, wide area network bandwidth, and internal connections (e.g., Wi-Fi). These questions ask about the current state of connectivity for schools and libraries, including services and equipment not funded by the E-rate program. Answers to these questions do not affect funding commitments.  If this information has already been entered into the applicant’s profile, it will be pre-populated into this submission. Note: Connectivity Questions will no longer be required in EPC beginning in FY 2019.
42	Entity Information & Discount Calculations	Consortium Discount Calculation	The system will calculate and display the discount rate, based on an average of student count data for all of the member entities participating on the FCC Form 471.
43	Contract Details	Contract Number	This is the number of the contract if services are being received under contract.
44	Contract Details	Contract Nickname	Applicants provide an easily identifiable name for the contract.
45	Contract Details	Has the applicant piggybacked off another contract or can other applicants use this contract to provide a competitive bid response (i.e., can they piggy back on this contract?) (Yes/No)	Piggybacking allows a contract negotiated by an entity to be used by other entities using the same terms of the contract. The contract issuer has to include piggybacking terms in the contract, and the vendor or contractor involved must agree. These contracts are traditionally for materials and equipment and are permitted only in certain jurisdictions.
46	Contract Details	State Master Contract?	If buying off of a master contract signed by a state, regional or local procurement agency on behalf of eligible schools and libraries, you may use either the master contract number or the number of your own purchase agreement executed pursuant to that master contract.
47	Contract Details	Billing Account Number With Service Provider	The account number that the service provider has established for billing purposes.
48	Contract Details	Allowable Vendor Selection/Contract Date	The system will determine and display the Allowable Vendor Selection/Contract Date based on the date of the posting of the establishing FCC Form 470.
49	Contract Details	Contract Award Date	The date that the contract for this service was executed.
50	Contract Details	Service Start Date	Provide the date when services will start in the funding year for which you are applying.
51	Contract Details	Service End Date	Provide the date when services will end.
52	Contract Details	Contract Expiration Date for Current Term	The date the current contract term expires.
53	Contract Details	Contract Expiration Date if all Extensions are exercised	If the contract for this FRN includes a clause that permits the parties to extend or renew the agreement at the end of the current contract period, indicate the expiration date of the contract if all extensions and renewals if all extensions were exercised.
54	Funding Request	Applicant FRN Nickname	Applicants can provide a unique name for each funding request number (FRN) for their own recordkeeping purposes.
55	Funding Request	Funding Request Number (FRN)	USAC’s online system assigns a unique number or FRN to each funding request.
56	Funding Request	Continuation of an FRN from a previous funding year, based on a multi-year contract? (Enter FRN)	Will be used to allow the system to copy FRN data from previous funding year. This will allow applicant to bypass the need to reenter data for this FRN and make only the changes that have occurred since the previous year.
57	Funding Request	Service Type	Choices include: Category One – Data Transmission and/or Internet Access; Voice Services Category Two – Internal Connections; Basic Maintenance of Internal Connections; Managed Internal Broadband Services. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
58	Funding Request	Data Transmission and/or Internet Access	If Data Transmission and/or Internet Access is selected, the applicant will be asked if the FRN includes a request for dark fiber, a self-provisioned network, special construction costs for a network such as special construction for fiber or wireless, equipment for an existing network such as modulating electronics and other equipment necessary to make a broadband service functional, or maintenance and operation costs for an existing network. This will lead the applicant on an alternate path through the form which will include questions about the following, if applicable: installment payment plans for special construction; state matching funds for special construction; attributes about fiber and non-fiber network facilities; and Network Equipment. Applicants will be offered online support to help them answer these questions correctly.
59	Funding Request	Establishing FCC Form 470 or Competitive Bidding Exemption	Applicant identifies the establishing FCC Form 470 or specifies the competitive bidding exemption: Business class high speed, low cost Internet Access; Preferred Master Contract.
60	Funding Request	Number of vendors who provided a responsive bid	Provide the number of vendors who provided a responsive bid for the services or products for which support is being requested in this funding request. Note that the criteria for responsiveness must be established in the original solicitation. This field is not required when support is requested for a product or service that is exempt from the requirement to post an FCC Form 470.
61	Funding Request	SPIN	The 9-digit SPIN for the service provider that will provide service(s) on this funding request.
62	Funding Request	Service Provider Name	The online system will populate the full legal name associated with the Service Provider Identification Number entered.
63	Funding Request	Tariffed or Month-to-Month Services	Indicates whether this funding request is for a non-contracted tariffed or month-to-month service.
64	Funding Request	Pricing Confidentiality?	Indicate if there is a restriction that prevents the pricing information provided from becoming public. If so, the applicant must describe the specific restriction and its source.
65	Funding Request –Special Construction	Installment Payment Plan for Non-Discount Portion of Special Construction Charge	Indicate whether the applicant has entered into an installment payment plan for the non-discounted portion of the special construction charge. If so, the applicant is required to enter: Total Amount Financed, Term (In Months), Annual Interest Rate, and indicate whether the agreement includes a balloon payment (Yes/No). Only applies to funding requests for special construction.
66	Funding Request –Special Construction	State or Tribal Matching Funds For Special Construction	The applicant will indicate whether it is receiving state or tribal matching funds for special construction. If yes, the applicant will be required to specify the dollar amount of the State or Tribal Match, expected connection speed (Mbps or Gbps), and source of matching funds as well as any supporting documents. Only applies to funding requests for special construction.
67	Funding Request –Special Construction	Construction Attributes for Fiber or Non-Fiber Facilities	Indicate whether the project is for fiber network facilities. If so, the applicant will be required to provide: Total project plant route feet; Average cost per foot of outside plant (does not include electronics); and Total Cost of fiber lighting and routing electronics. If the construction charges are for non-fiber facilities (e.g., microwave facilities), the applicant is required to provide a breakdown and description of the construction costs. Applicant will also be asked if the construction is for lit fiber, dark fiber or a self-provisioned network. Only applies to funding requests for special construction.
68	Funding Request – Network Equipment (Category One)	Network Equipment (Category One)	Applicants to identify: type, make, model, qty., costs (monthly and one-time), whether installation costs are included, and eligible versus ineligible costs.
69	If the funding requested above in the “Funding Request” section is for “Category One – Data Transmission and/or Internet Access; Voice Services,” applicants fill out the “Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services” section. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
70	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Narrative	Each Funding Request must include a description of the products and services for which discounts are being sought. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
71	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice Services	Type of Connection	Only applicable to Category One FRNs. Provides dropdowns of services starting with Fiber, Copper, Wireless, Other. Subtypes are provided from the eligible services list (ESL). Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
72	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Purpose of the Connection	Only appears for Category One Once an applicant selects its connection type, it will be asked to select the purpose of the connection. For example, if the applicant has selected standalone Internet access, the purpose it indicates would be Internet access with no circuit. Purposes that include Internet access will require CIPA compliance. Purposes that do not include Internet access, such as data connection(s) where Internet access service is billed separately from the connection and not included in the FRN, will not require CIPA compliance. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
73	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Quantity or # of lines	Only appears for Category One Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
74	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Bandwidth Upload speed	Only appears for Category One Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
75	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Bandwidth Download speed (if different)	Only appears for Category One Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
76	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Burstable bandwidth? (Yes/No) If yes, insert max speed	Only appears for Category One for Internet access Note: Options for selecting voice services will no longer be included on the Form 471.
77	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Basic firewall protection included? (Yes/No)	Only appears for Category One for Internet access Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
78	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Recipient(s) of Service (Entity Numbers)	From the list of entities associated with the applicant’s profile, the applicant would select the entity(ies) for which the line item provides connectivity either directly or indirectly. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
79	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Direct Connection? (Yes/No)	The applicant is asked whether this a direct connection to the school, library or NIF. These three types of locations represent all physical locations to which USAC would provide E-Rate support for services. This is a direct connection. (Note: Formerly, this question used the terminology “last mile” instead of “direct connection”). Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
80	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Other Connection That is Not a “Direct” Connection? (Yes/No)?	The applicant is asked if this another type of connection that is eligible for support but is not a direct connection to a school, library or NIF. These are eligible connections sought by the applicant that do not go directly to a school, library or NIF (e.g., WAN connections may both provide a direct connection to a school, library or NIF but may also provide connections that do not go directly to the school, library or NIF). Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
81	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Monthly Recurring Cost	Enter the monthly recurring cost for the product or service. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
82	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice ServicesData Transmission and/or Internet Access; Voice Services	Monthly Recurring Ineligible Cost	Enter the monthly recurring ineligible cost for the product or service. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
83	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice Services	Monthly Recurring Eligible Cost	System generated
84	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice Services	One-time Eligible Cost Per Unit	Enter the one-time or non-recurring costs for the product or service. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
85	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice Services	Total One Time Eligible Costs	System generated
86	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice Services	One Time Ineligible Cost	Enter the one-time or non-recurring ineligible costs for the product or service. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
87	Funding Request – Line Item for Data Transmission and/or Internet Access; Voice Services	Extended Line Item Cost	The system will automatically calculate the total pre-discount amount for this FRN line, based on the information provided. Note: Options for selecting voice services will no longer be included on the Form 471 commencing July 1, 2018.
88	If the funding requested above in the “Funding Request” section is for “Category Two – Internal Connections,” applicants fill out the “Funding Request – Line Item for Internal Connections” section.
89	Funding Request – Line Item for Internal Connections	Narrative	Each Funding Request must include a description of the products and services for which discounts are being sought.
90	Funding Request – Line Item for Internal Connections	Type of Internal Connections (IC) (drop down)	Only applicable to Category Two FRNs. Drop down values are provided to applicant based on Eligible Services List. Only one type per line item.
91	Funding Request – Line Item for Internal Connections	Installation Included in Price?	Only for IC
92	Funding Request	Quantity and Unit	Quantity of IC being requested (e.g. 10 wireless access points).
93	Funding Request – Line Item for Internal Connections	Make	For Category Two Internal Connections. Only one make per line item.
94	Funding Request – Line Item for Internal Connections	Model	For Category Two Internal Connections. Only one model per line item.
95	Funding Request – Line Item for Internal Connections	Lease or Non-Purchase Arrangement (Yes/No)	Indicate if this is being procured under a lease or non-purchase arrangement.
96	Funding Request – Line Item for Internal Connections	Monthly Recurring Cost	Enter the monthly recurring cost for the product or service.
97	Funding Request – Line Item for Internal Connections	Monthly Recurring Ineligible Cost	Enter the monthly recurring ineligible cost for the product or service.
98	Funding Request – Line Item for Internal Connections	Monthly Recurring Eligible Cost	System generated
99	Funding Request – Line Item for Internal Connections	One-time Eligible Cost Per Unit	Enter the one-time or non-recurring costs for the product or service.
100	Funding Request – Line Item for Internal Connections	Total One Time Eligible Costs	System generated
101	Funding Request – Line Item for Internal Connections	One Time Ineligible Cost	Enter the one-time or non-recurring ineligible costs for the product or service.
102	Funding Request – Line Item for Internal Connections	Extended Line Item Cost	The system will automatically calculate the total pre-discount amount for this FRN line, based on the information provided.
103	Funding Request – Line Item for Internal Connections	Category Two Cost-Allocation	For Category Two funding requests, applicants are required to allocate the cost of the products or services among the recipients of service. The applicant may use any method for allocating the costs, as long as the cost-allocation methodology is based on tangible criteria and reaches a realistic result.
104	Funding Request – Line Item for Internal Connections	Recipient(s) of Service (Entity Numbers)	From the list of entities generated by the system, the applicant would select the entity(ies) for which the line item provides internal connectivity.
105	If the funding requested above in the “Funding Request” section is for “Category Two – Managed Internal Broadband Services,” applicants fill out the “Funding Request – Line Item for Managed Internal Broadband Services” section.
106	Funding Request – Line Item for Managed Internal Broadband Services	Narrative	Each Funding Request must include a description of the products and services for which discounts are being sought.
107	Funding Request – Line Item for Managed Internal Broadband Services	FRN Line item number	Each Funding Request must include a description of the products and services for which discounts are being sought. Applicants complete one or more line-item entries for all products or services in the funding request for the identified service type.
108	Funding Request – Line Item for Managed Internal Broadband Services	Type of Managed Service Agreement	For Category Two “Managed Internal Broadband Services”, the applicant is required to select from: (1) managed and leased from a third party service provider; (2) managed by third party service provider; (3) purchased from them or other vendors; or (4) managed services contract of already installed equipment.
109	Funding Request – Line Item for Managed Internal Broadband Services	Monthly Recurring Cost	Enter the monthly recurring cost for the product or service.
110	Funding Request – Line Item for Managed Internal Broadband Services	Monthly Recurring Ineligible Cost	Enter the monthly recurring ineligible cost for the product or service.
111	Funding Request – Line Item for Managed Internal Broadband Services	Monthly Recurring Eligible Cost	System generated
112	Funding Request – Line Item for Managed Internal Broadband Services	One-time Eligible Cost Per Unit	Enter the one-time or non-recurring costs for the product or service.
113	Funding Request – Line Item for Managed Internal Broadband Services	Total One Time Eligible Costs	System generated
114	Funding Request – Line Item for Managed Internal Broadband Services	One Time Ineligible Cost	Enter the one-time or non-recurring ineligible costs for the product or service.
115	Funding Request – Line Item for Managed Internal Broadband Services	Extended Line Item Cost	The system will automatically calculate the total pre-discount amount for this FRN line, based on the information provided.
116	Funding Request – Line Item for Managed Internal Broadband Services	Recipient(s) of Service (Entity Numbers)	From the list of entities generated by the system, the applicant would select the entity(ies) for which the line item provides internal connectivity.
117	If the funding requested above in the “Funding Request” section is for “Category Two – Basic Maintenance of Internal Connections,” applicants fill out the “Funding Request – Line Item for Basic Maintenance of Internal Connections” section.
118	Funding Request – Line Item for Basic Maintenance of Internal Connections	Narrative	Each Funding Request must include a description of the products and services for which discounts are being sought.
119	Funding Request – Line Item for Basic Maintenance of Internal Connections	FRN Line item number	Each Funding Request must include a description of the products and services for which discounts are being sought. Applicants complete one or more line-item entries for all products or services in the funding request for the identified service type.
120	Funding Request – Line Item for Basic Maintenance of Internal Connections	Quantity	Total quantity of equipment maintained.
121	Funding Request – Line Item for Basic Maintenance of Internal Connections	Monthly Recurring Cost	Enter the monthly recurring cost for the product or service.
122	Funding Request – Line Item for Basic Maintenance of Internal Connections	Monthly Recurring Ineligible Cost	Enter the monthly recurring ineligible cost for the product or service.
123	Funding Request – Line Item for Basic Maintenance of Internal Connections	Monthly Recurring Eligible Cost	System generated
124	Funding Request – Line Item for Basic Maintenance of Internal Connections	One-time Eligible Cost Per Unit	Enter the one-time or non-recurring costs for the product or service.
125	Funding Request – Line Item for Basic Maintenance of Internal Connections	Total One Time Eligible Costs	System generated
126	Funding Request – Line Item for Basic Maintenance of Internal Connections	One Time Ineligible Cost	Enter the one-time or non-recurring ineligible costs for the product or service.
127	Funding Request – Line Item for Basic Maintenance of Internal Connections	Extended Line Item Cost	The system will automatically calculate the total pre-discount amount for this FRN line, based on the information provided.
128	Funding Request – Line Item for Basic Maintenance of Internal Connections	Recipient(s) of Service (Entity Numbers)	From the list of entities generated by the system, the applicant would select the entity(ies) for which the line item provides maintenance on eligible internal connectivity.
129	Funding Request – Line Item for Basic Maintenance of Internal Connections	BMIC Cost Allocation % (if not 100% eligible)	Cost allocation percentage (if either the product being maintained is not 100 percent eligible or the cost of the maintenance itself is not fully eligible).
130	Category Two Budget Information	Category Two Budget Summary	System will generate a report on the applicant’s used and available budget.
131	Certifications	Signature of Authorized Person	The form must be certified electronically with the authorized person’s applicant name and password.
132	Certifications	Date Signed	Auto generated by system.
133	Certifications	Name of Authorized Person	This is the name of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
134	Certifications	Title or Position of Authorized Person	This is the title of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
135	Certifications	Physical or mailing address of Authorized Person	This is the address (can be physical address or mailing address) of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
136	Certifications	Telephone Number of Authorized Person	This is the telephone number of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
137	Certifications	Email address of Authorized Person	This is the email address of the authorized person signing the form. This will be prepopulated based on the profile of the applicant signing the form electronically.
138	Certifications – eligible entities – schools only	I certify that the entities listed in this application are eligible for support because they are schools under the statutory definitions of elementary and secondary schools found in the No Child Left Behind Act of 2001, 20 U.S.C. §§ 7801(18) and (38), that do not operate as for-profit businesses and do not have endowments exceeding $50 million.	Only this certification shows if schools are the only entities seeking funding on this application.
139	Certifications – eligible entities – libraries only	I certify that the entities listed in this application are eligible for support because they are libraries or library consortia eligible for assistance from a State library administrative agency under the Library Services and Technology Act of 1996 that do not operate as for-profit businesses and whose budgets are completely separate from any schools, including, but not limited to, elementary, secondary schools, colleges, or universities.	Only this certification shows if libraries are the only entities seeking funding on this application.
140	Certifications – eligible entities – both schools and libraries	I certify that the entities listed in this application are eligible for support because they are schools under the statutory definitions of elementary and secondary schools found in the No Child Left Behind Act of 2001, 20 U.S.C. §§ 7801(18) and (38), that do not operate as for-profit businesses and do not have endowments exceeding $50 million, and they are libraries or library consortia eligible for assistance from a State library administrative agency under the Library Services and Technology Act of 1996 that do not operate as for-profit businesses and whose budgets are completely separate from any schools, including, but not limited to, elementary, secondary schools, colleges, or universities.	Only this certification shows if both schools and libraries are entities seeking funding on this application.
141	Certifications – necessary resources – installment payments	I certify that the entity I represent or the entities listed on this application have secured access, separately or through this program, to all of the resources, including computers, training, software, internal connections, maintenance, and electrical capacity, necessary to use the services purchased effectively. I recognize that some of the aforementioned resources are not eligible for support. I certify that the entities I represent or the entities listed on this application have secured access to all of the resources to pay the discounted charges for eligible services from funds to which access has been secured in the current funding year. For entities I represent or the entities listed on this application that enter into installment payments with their service providers for the non-discounted portion of special construction costs, I certify that they are able to make all required installment payments. I certify that the Billed Entity will pay the non-discount portion of the cost of the goods and services to the service provider(s). Total funding year pre-discount eligible amount on this FCC Form 471 (sum of entries in the Funding Requests). (Auto-populated) Total funding commitment request amount on this FCC Form 471 (Auto-populated) Total applicant non-discount share of eligible amount (Auto-populated) Total amount allocated to resources not eligible for E-rate support Total applicant non-discounted share of eligible amount, plus the total amount allocated to resources not eligible for E-rate support. (Sum of (c) and (d)) Are you are receiving any of the funds directly from a service provider listed on any of the FCC Forms 471 filed by this Billed Entity for this funding year? Has a service provider listed on any of the FCC Forms 471 filed by this Billed Entity for this funding year assisted you in locating funds needed to pay your non-discounted share?	This version of the certification will show up only for the applicants that have indicated that they HAVE entered into installment payments with their service providers for the non-discounted portion of special construction costs. These amounts are all auto-populated: Total funding year pre-discount; Total funding commitment request amount; Total applicant non-discount share; Total budgeted amount allocated to resources not eligible for E-rate support; Total amount necessary for the applicant to pay the non-discount share of the services requested on this application AND to secure access to the resources necessary to make effective use of the discounts.
142	Certifications – necessary resources – no installment payments	I certify that the entity I represent or the entities listed on this application have secured access, separately or through this program, to all of the resources, including computers, training, software, internal connections, maintenance, and electrical capacity, necessary to use the services purchased effectively. I recognize that some of the aforementioned resources are not eligible for support. I certify that the entities I represent or the entities listed on this application have secured access to all of the resources to pay the discounted charges for eligible services from funds to which access has been secured in the current funding year. I certify that the Billed Entity will pay the non-discount portion of the cost of the goods and services to the service provider(s). Total funding year pre-discount eligible amount on this FCC Form 471 (sum of entries in the Funding Requests). (Auto-populated) Total funding commitment request amount on this FCC Form 471 (Auto-populated) Total applicant non-discount share of eligible amount (Auto-populated) Total amount allocated to resources not eligible for E-rate support Total applicant non-discounted share of eligible amount, plus the total amount allocated to resources not eligible for E-rate support. (Sum of (c) and (d)) Are you are receiving any of the funds directly from a service provider listed on any of the FCC Forms 471 filed by this Billed Entity for this funding year? Has a service provider listed on any of the FCC Forms 471 filed by this Billed Entity for this funding year assisted you in locating funds needed to pay your non-discounted share?	This version of the certification will show up only for the applicants that have indicated that they HAVE NOT entered into installment payments with their service providers for the non-discounted portion of special construction costs. These amounts are all auto-populated: Total funding year pre-discount; Total funding commitment request amount; Total applicant non-discount share; Total budgeted amount allocated to resources not eligible for E-rate support; Total amount necessary for the applicant to pay the non-discount share of the services requested on this application AND to secure access to the resources necessary to make effective use of the discounts.
143	Certifications – Competitive Bidding Certification	I certify an FCC Form 470 was posted and that any related RFP was made available for at least 28 days before considering all bids received and selecting a service provider. I certify that all bids submitted were carefully considered and the most cost-effective service offering was selected, with price being the primary factor considered, and is the most cost-effective means of meeting educational needs and technology goals.	Certification will show if there are FRNs that are not covered by competitive bidding exemptions as indicated earlier in the application. Exemptions include: Business class high speed, low cost Internet Access; Preferred Master Contract
144	Certifications – Business Class Internet	I certify that I selected an eligible commercially available business-class Internet access service exempt from the requirement to post an FCC Form 470.	Certification will only show if the applicant indicates that it selected an eligible commercially available business-class Internet access service on this form.
145	Certifications – Preferred Master Contract	I certify that I ordered eligible Category Two equipment from a preferred master contract exempt from the requirement to post an FCC Form 470.	Certification will only show if the applicant indicates that it selected eligible Category Two equipment from an eligible preferred master contract on this form. Note: To date, the Commission has not designated any preferred master contracts.
146	Certifications – Procurement Rules	I certify that the entity responsible for selecting the service provider(s) has reviewed all applicable FCC, state, and local procurement/competitive bidding requirements and that the entity or entities listed on this application have complied with them.
147	Certifications – Educational Purposes	I certify that the services the applicant purchases at discounts provided by 47 U.S.C. § 254 will be used primarily for educational purposes, see 47 C.F.R. § 54.500 and will not be sold, resold or transferred in consideration for money or any other thing of value, except as permitted by the Commission’s rules at 47 C.F.R. § 54.513. Additionally, I certify that the entity or entities listed on this application have not received anything of value or a promise of anything of value, as prohibited by the Commission’s rules at 47 C.F.R. § 54.503(d), other than services and equipment sought by means of this form, from the service provider, or any representative or agent thereof or any consultant in connection with this request for services.
148	Certifications – Compliance with Program Rules	I certify that I and the entity(ies) I represent have complied with all program rules and I acknowledge that failure to do so may result in denial of discount funding and/or cancellation of funding commitments. There are signed contracts or other legally binding agreements covering all of the services listed on this FCC Form 471 except for those services provided under non-contracted tariffed or month-to-month arrangements. I acknowledge that failure to comply with program rules could result in civil or criminal prosecution by the appropriate law enforcement authorities.
149	Certifications – Shared Services	I acknowledge that the discount level used for shared services is conditional, for future years, upon ensuring that the most disadvantaged schools and libraries that are treated as sharing in the service, receive an appropriate share of benefits from those services.
150	Certifications – Document Retention	I certify that I will retain required documents for a period of at least 10 years (or whatever retention period is required by the rules in effect at the time of this certification) after the later of the last day of the applicable funding year or the service delivery deadline for the associated funding request. I acknowledge that I may be audited pursuant to participation in the schools and libraries program. I certify that I will retain all documents necessary to demonstrate compliance with the statute and Commission rules regarding the application for, receipt of, and delivery of services receiving schools and libraries discounts, and that if audited, I will make such records available to USAC.
151	Certifications – Authority to Order Services	I certify that I am authorized to order telecommunications and other supported services for the eligible entity(ies) listed on this application. I certify that I am authorized to submit this request on behalf of the eligible entity(ies) listed on this application, that I have examined this request, that all of the information on this form is true and correct to the best of my knowledge, that the entities that are receiving discounts pursuant to this application have complied with the terms, conditions and purposes of the program, that no kickbacks were paid to anyone and that false statements on this form can be punished by fine or forfeiture under the Communications Act, 47 U.S.C. §§ 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. § 1001 and civil violations of the False Claims Act.
152	Certifications – Debarment	I acknowledge that FCC rules provide that persons who have been convicted of criminal violations or held civilly liable for certain acts arising from their participation in the schools and libraries support mechanism are subject to suspension and debarment from the program. I will institute reasonable measures to be informed, and will notify USAC should I be informed or become aware that I or any of the entities listed on this application, or any person associated in any way with my entity and/or the entities listed on this application, is convicted of a criminal violation or held civilly liable for acts arising from their participation in the schools and libraries support mechanism.
153	Certifications – Cost Allocation	I certify that if any of the Funding Requests on this FCC Form 471 are for discounts for products or services that contain both eligible and ineligible components, that I have allocated the eligible and ineligible components as required by the Commission's rules at 47 C.F.R. § 54.504.
154	Certifications	I certify that the non-discount portion of the costs for eligible services will not be paid by the service provider. The pre-discount costs of eligible services featured on this FCC Form 471 are net of any rebates or discounts offered by the service provider. I acknowledge that, for the purpose of this rule, the provision, by the provider of a supported service, of free services or products unrelated to the supported service or product will be considered a rebate of some or all of the cost of the supported services.

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