FCC Form 471 Description of Services Requested and Certification Form

OMB Control No. 3060-1323 Estimated Time per Response

[Month] 2024 5 hours

Not Yet Approved by OMB

Schools and Libraries Cybersecurity Pilot Program

Description of Services Requested and Certification FCC Form 471 (using FCC Form 471 and ECF FCC Form 471 information collection requirements approved pursuant to OMB Control Nos. 3060-0806 and 3060-1286)

(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 participant will see. Where possible, information already 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).

Item Number	Section	Field Description	Purpose/Instructions
1	Basic Information	Participant’s Form Nickname	To create a unique identifier for this submission, the participant simply enters a nickname (e.g., 2016 FY ABC School Form 471).
2	Basic Information	FCC Form 471 Application Number	Auto-generated by the system: This is an Administrator-assigned unique identifier for this submission.
3	Basic Information	Participant 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 participant’s profile, it will be pre-populated into this submission.
4	Basic Information	Pilot Program Year	Auto-generated by the system based on the applicable year of the Schools and Libraries Cybersecurity Pilot Program: This is the Pilot Program Year for which equipment and services are sought.
5	Basic Information	Entity Number	Auto-generated by the system: This is the Unique identifier assigned by the Administrator to the organization listed in Participant Name.
6	Basic Information	FCC Registration Number	This is the unique FCC identifier for the organization listed as the participant. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
7	Basic Information	Unique Entity Identifier (UEI) Number	This is a unique identifier for the organization listed as the participant. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
8	Basic Information	Mailing Address	This is the mailing address for the participant. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
9	Basic Information	Telephone Number	This is the main telephone line for the participant 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 participant’s profile, it will be pre-populated into this submission.
10	Basic Information	Type of Participant	Options are: school, school district, library/library system, consortium, or statewide consortium. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
11	Basic Information	Participant Attributes	Attributes for a School or School District include: Public, Private, Charter, and Educational State Agency (ESA). Attributes for a Library System include: Public and Private. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
12	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 participant’s profile, it will be pre-populated into this submission.
13	Basic Information	E-mail Address	E-mail Address of the Contact Person. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
14	Basic Information	Contact Person’s Telephone Number	Telephone Number of the Contact Person. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
15	Basic Information	Holiday/vacation/summer contact information	This line will collect the name, phone number, and email of the holiday/vacation/summer contact.
16	Basic Information	Website	Website URL for school, school district, library, or consortium, etc. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
17	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 participant’s profile, it will be pre-populated into this submission.
18	Entity Information	Entity Number	Unique identifier assigned by the Administrator to each school, library outlet/branch, or Non-Instructional Facility (NIF).
19	Entity Information	Name of the Individual School or Library Outlet/Branch, or NIF Name	If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
20	Entity Information	Physical Address	Physical address of each Individual School or Library Outlet/Branch. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
21	Entity Information	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 be pre-populated into this submission by the Administrator, if available.
22	Entity Information	Urban or Rural	The system will automatically determine the Urban/Rural status of the entity based on the physical address associated with the entity.
23	Entity Information	Tribal Entities and Tribal Affiliation	For each Tribal entity, this line will collect the Tribal affiliation. If the entity qualifies as Tribal, it will also include their Tribal Affiliation. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
24	Entity Information	NIFs	Indicates whether the entity is a NIF. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
25	Entity Information	State Local Education Agency (LEA) ID	State school IDs (LEA code and school code). If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
26	Entity Information	State School ID	State school IDs (LEA code and school code). If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
27	Entity Information	Endowment Amount (Dollars)	Schools and school districts 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 for Schools and Libraries Cybersecurity Pilot Program funding because they meet the statutory definition of an “elementary” or “secondary” school as defined in 47 CFR § 54.2000, do not operate as for-profit businesses, and do not have endowments exceeding $50 million.
28	Entity Information	Maximum number of students on school premises at the same time	This field is defined as the maximum number of students on the premises at the same time. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
29	Entity Information	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 participant’s profile, it will be pre-populated into this submission.
30	Entity Information	Alternative Discount	Participant will indicate if it used an alternative discount methodology, such as a survey. Participant will also indicate whether it has adopted the Community Eligibility Program (CEP) and, if so, provide the percentage of direct certification students.
31	Entity Information	School Attributes	The list of attributes for a School includes: Public, Private, Pre-Kindergarten, Head Start, Adult Education, Juvenile Justice, Dormitory, Charter, Tribal, New Construction, and ESA. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
32	Entity Information	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 participant’s profile, it will be pre-populated into this submission.
33	Entity Information	Library Main Branch? (Yes/No)	Used to determine if a library is a main branch. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
34	Entity Information	Billed Entity Number	The Administrator assigns a billed entity number (BEN) to the entity who pays the Service Provider for equipment and/or services delivered to eligible schools and libraries. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
35	Entity Information	Library Attributes	The list of attributes for a Library includes: Public, Private, Academic, Research, Tribal, Tribal College or University, Bookmobile, Kiosk, New Construction, Main Branch, and State Library Agency. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
36	Entity Information	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. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
37	Entity Information	Total Number of Students Enrolled in School District	Total number of students in the school district should include all of the students in the school district as a whole, counting each student only once. If this information has already been entered into the participant’s profile, it will be pre-populated into this submission.
38	Entity Information	Percentage of Students in School District Eligible for NSLP	This is the percentage of students in the school district that are eligible for the National School Lunch Program (NSLP).
39	Entity Information	E-Rate Category One Discount Rate	System determines the discount rate that applies to E-Rate Category One service.
40	Entity Information	Consortium E-Rate Discount Calculation and Rate	The system will calculate and display the consortium discount percentage rate, based on an average of student count data for all of the member entities participating on the FCC Form 471.
41	Entity Information	Schools and Libraries Cybersecurity Pilot Program Discount Rate	System determines the discount rate that will apply to the Pilot Program.
42	Contract Details	Contract Number	This is the number of the contract if the equipment and/or services are being received under contract.
43	Contract Details	Contract Nickname	Participants can provide a unique name for the contract.
44	Contract Details	Has the participant piggybacked off another contract or can other participants 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.
45	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, a participant may use either the master contract number or the number of its own purchase agreement executed pursuant to that master contract.
46	Contract Details	Billing Account Number With Service Provider	The account number that the Service Provider has established for billing purposes.
47	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.
48	Contract Details	Contract Award Date	The date that the contract for the equipment and/or services was executed.
49	Contract Details	Service Start Date	Provide the date when services will start in the Pilot Program year for which the participant is applying.
50	Contract Details	Service End Date	Provide the date when services will end.
51	Contract Details	Contract Expiration Date for Current Term	The date the current contract term expires.
52	Contract Details	Contract Expiration Date if all Extensions are Exercised	If the contract 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 were exercised.
53	Funding Request	Participant Funding Request Numbers (FRN) Nickname	Participants can provide a unique name for each FRN for their own recordkeeping purposes.
54	Funding Request	Funding Request Number (FRN)	A system-generated unique number or FRN to each funding request.
55	Funding Request	Continuation of an FRN from a previous Pilot Program year, based on a multi-year contract? (Enter FRN)	A participant FRN will be used to allow the system to copy FRN data from a previous Pilot Program year. This will allow the participant to bypass the need to reenter data for the continuing FRN and make only the changes that have occurred since the previous Pilot Program year.
56	Funding Request	Equipment or Service Type	Participant to provide a description of the type of equipment or service requested.
57	Funding Request	Establishing FCC Form 470 or Competitive Bidding Exemption	Participant identifies the establishing Schools and Libraries Cybersecurity Pilot Program FCC Form 470 for the FRN or specifies an applicable competitive bidding exemption.
58	Funding Request	Number of vendors who provided a responsive bid	Provide the number of vendors who provided a responsive bid for the eligible equipment or services for which support is being requested in the 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 equipment or services that are exempt from the requirement to post an FCC Form 470.
59	Funding Request	Service Provider Identification Number (SPIN)	The 9-digit SPIN for the Service Provider that will provide service(s) for the funding request.
60	Funding Request	Service Provider Name	The online system will populate the full legal name associated with the SPIN entered. Participant will manually input this information if the Service Provider information is not already in the system.
61	Funding Request	Service Provider Contact Information	Name, Address, and Phone Number if the participant is using a Service Provider who does not have a SPIN number. Participant will manually input this information if the Service Provider information is not already in the system.
62	Funding Request	Tariffed or Month-to-Month Services	Indicates whether this funding request is for a non-contracted tariffed or month-to-month service.
	If the funding requested above in the “Funding Request” section is for “Services,” participants fill out the “Funding Request – Line Item for Cybersecurity Services” section.
63	Funding Request – Line Item for Cybersecurity Services	Narrative	Each Funding Request must include a description of the cybersecurity services being requested. Participants will also be able to use this field to provide additional information for their request and upload supporting documentation.
64	Funding Request – Line Item for Cybersecurity Services	Type of Service	Participants will indicate the type of service sought in the funding request through a combination of drop down menus and narrative text.
65	Funding Request – Line Item for Cybersecurity Services	Service Function	Participants will indicate the functions of the services sought in the funding request through a combination of drop down menus and narrative text.
66	Funding Request – Line Item for Cybersecurity Services	Service Quantity	Participants will indicate the quantities of the services sought in the funding request through a combination of drop down menus and narrative text.
67	Funding Request – Line Item for Cybersecurity Services	Bandwidth Upload speed	Only appears for services requests. Only needs to be completed if applicable to the requested Cybersecurity service.
68	Funding Request – Line Item for Cybersecurity Services	Bandwidth Download speed (if different)	Only appears for services requests. Only needs to be completed if applicable to the requested Cybersecurity service.
69	Funding Request – Line Item for Cybersecurity Services	Recipient(s) of Service (Entity Numbers)	From the list of entities associated with the participant’s profile, the participant would select the entity(ies) for which the line item provides cybersecurity services, either directly or indirectly.
70	Funding Request – Line Item for Cybersecurity Services	Direct Connection? (Yes/No)	The participant is asked whether the cybersecurity service will use a direct connection to the school, library, or NIF.
71	Funding Request – Line Item for Cybersecurity Services	Other Connection That is Not a “Direct” Connection? (Yes/No)?	The participant is asked whether the cybersecurity service will use another type of connection that is not a direct connection to a school, library, or NIF. These are eligible connections sought by the participant that do not go directly to a school, library, or NIF (e.g., WAN connections may provide both 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).
72	Funding Request – Line Item for Cybersecurity Services	Monthly Recurring Unit Cost	Participants will indicate the monthly recurring unit cost of the services sought in the funding request through a combination of drop down menus and narrative text.
73	Funding Request – Line Item for Cybersecurity Services	Monthly Recurring Ineligible Cost	Participants will indicate the monthly recurring ineligible cost of the services sought in the funding request through a combination of drop down menus and narrative text.
74	Funding Request – Line Item for Cybersecurity Services	Monthly Recurring Eligible Cost	Participants will indicate the monthly recurring eligible cost of the services sought in the funding request through a combination of drop down menus and narrative text.
75	Funding Request – Line Item for Cybersecurity Services	Monthly Quantity of Recurring Services	Participants will indicate the monthly quantity of recurring services sought in the funding request through a combination of drop down menus and narrative text.
76	Funding Request – Line Item for Cybersecurity Services	Months of Service	Participants will indicate the total months the services will be sought in the funding request through a combination of drop down menus and narrative text.
77	Funding Request – Line Item for Cybersecurity Services	Monthly Recurring Cost	Participants will indicate the monthly recurring cost of the services sought in the funding request through a combination of drop down menus and narrative text.
78	Funding Request – Line Item for Cybersecurity Services	One-time Unit Cost	Participants will indicate the one-time unit cost for the services sought in the funding request through a combination of drop down menus and narrative text.
79	Funding Request – Line Item for Cybersecurity Services	One-Time Quantity	Participants will indicate the one-time quantity of the services sought in the funding request through a combination of drop down menus and narrative text.
80	Funding Request – Line Item for Cybersecurity Services	Total One-Time Cost	Participants will indicate the total one-time cost of the services sought in the funding request through a combination of drop down menus and narrative text.
81	Funding Request – Line Item for Cybersecurity Services	One-Time Ineligible Cost	Participants will indicate the one-time ineligible cost of the services sought in the funding request through a combination of drop down menus and narrative text.
82	Funding Request – Line Item for Cybersecurity Services	Extended Line Item Cost	The system will automatically calculate the total pre-discount amount for this FRN line, based on the information provided.
If the funding requested above in the “Funding Request” section is for “Equipment,” participants fill out the “Funding Request – Line Item for Cybersecurity Equipment” section.
83	Funding Request – Line Item for Cybersecurity Equipment	Narrative	Each Funding Request must include a description of the cybersecurity equipment being requested. Participants will also be able to use this field to provide additional information for their request and upload supporting documentation.
84	Funding Request – Line Item for Cybersecurity Equipment	Type of Equipment	Participants will indicate the type of equipment sought in the funding request through a combination of drop down menus and narrative text.
85	Funding Request – Line Item for Cybersecurity Equipment	Make	For cybersecurity equipment requests. Only one make per line item.
86	Funding Request – Line Item for Cybersecurity Equipment	Model	For cybersecurity equipment requests. Only one model per line item.
87	Funding Request – Line Item for Cybersecurity Equipment	One-time Unit Cost	Participants will indicate the one-time unit cost of the equipment sought in the funding request through a combination of drop down menus and narrative text.
88	Funding Request – Line Item for Cybersecurity Equipment	One-Time Quantity	Participants will indicate the one-time quantity of the equipment sought in the funding request through a combination of drop down menus and narrative text.
89	Funding Request – Line Item for Cybersecurity Equipment	Total One-Time Cost	Participants will indicate the total one-time cost of the equipment sought in the funding request through a combination of drop down menus and narrative text.
90	Funding Request – Line Item for Cybersecurity Equipment	One-Time Ineligible Cost	Participants will indicate the one-time ineligible cost of the equipment sought in the funding request through a combination of drop down menus and narrative text.
91	Funding Request – Line Item for Cybersecurity Equipment	Extended Line Item Cost	The system will automatically calculate the total amount for this FRN line, based on the information provided.
	Recipient of Service Information – Requested for Consortium applications only
92	Funding Request – Consortium Applications	Recipients of Service	From the list of entities associated with the participant’s profile, the participant would select the entity(ies) for whom the line item provides cybersecurity services.
93	Funding Request – Consortium Applications	Cost Allocation for Recipients of Cybersecurity Service	Enter the dollar amount provided for each recipient of cybersecurity service.
Invoicing Mode Selected
94	Invoicing Mode Selected	Invoicing Mode Selected	Participants will be required to select whether they will be invoicing the Administrator for the requested eligible equipment and/or service or if their Service Provider(s) will be invoicing the Administrator for the requested eligible equipment and services.
95	Invoicing Mode Selected	FCC Registration Number	This is the unique FCC identifier for the organization listed as the Service Provider who agreed to invoice the Administrator on behalf of the participant. The participant will be asked to input this number on the application if the Service Provider’s FCC Registration number cannot be pre-populated.
96	Invoicing Mode Selected	Unique Entity Identification (UEI) Number	The UEI number is a unique nine-digit identifier for businesses. The participant will be asked to input the UEI number of the Service Provider who agreed to invoice the Administrator on behalf of the participant if the Service Provider’s UEI number cannot be pre-populated.
Certifications
97	Certifications	Signature of Authorized Person	The form must be certified electronically with the authorized person’s participant name and password.
98	Certifications	Date Signed	Auto generated by system.
99	Certifications	Name of Authorized Person	This is the name of the authorized person signing the form. This will be pre-populated based on the profile of the participant signing the form electronically.
100	Certifications	Title or Position of Authorized Person	This is the title of the authorized person signing the form. This will be pre-populated based on the profile of the participant signing the form electronically.
101	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 pre-populated based on the profile of the participant signing the form electronically.
102	Certifications	Telephone Number of Authorized Person	This is the telephone number of the authorized person signing the form. This will be pre-populated based on the profile of the participant signing the form electronically.
103	Certifications	Email Address of Authorized Person	This is the email address of the authorized person signing the form. This will be pre-populated based on the profile of the participant signing the form electronically.
104	Certifications	I am authorized to submit this application on behalf of the above-named participant and that based on information known to me or provided to me by employees responsible for the data being submitted, I hereby certify that the data set forth in this application has been examined and is true, accurate, and complete. I acknowledge that any false statement on this application or on any other documents submitted by this participant 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), or can lead to liability under the False Claims Act (31 U.S.C. §§ 3729–3733).	The authorized person will be required to make the following certifications to be able to submit the request for funding. The certifications are necessary to ensure the participant is compliant with the Schools and Libraries Cybersecurity Pilot Program rules and to protect the Program from waste, fraud, and abuse.
105	Certifications	In addition to the foregoing, this participant is in compliance with the rules and orders governing the Schools and Libraries Cybersecurity Pilot Program, and I acknowledge that failure to be in compliance and remain in compliance with those rules and orders may result in the denial of funding, cancellation of funding commitments, and/or recoupment of past disbursements. I acknowledge that failure to comply with the rules and orders governing the Schools and Libraries Cybersecurity Pilot Program could result in civil or criminal prosecution by law enforcement authorities.	See number 104.
106	Certifications	By signing this application, I certify that the information contained in this application is true, complete, and accurate, and the projected expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise. (U.S. Code Title 18, §§ 1001, 286-287 and 1341, and Title 31, §§ 3729–3730 and 3801–3812).	See number 104.
107	Certifications	The school meets the statutory definition of “elementary school” or “secondary school” as defined in § 54.2000, does not operate as a for-profit business, and does not have endowments exceeding $50,000,000.	This certification only shows if schools and/or consortia are the only entities seeking funding on this application. See also number 104.
108	Certifications	The library or library consortia is eligible for assistance from a State library administrative agency under the Library Services and Technology Act, does not operate as a for-profit business and, except for the limited case of Tribal college and university libraries, have budgets that are completely separate from any school (including, but not limited to, elementary and secondary schools, colleges, and universities).	This certification only shows if libraries and/or consortia are the only entities seeking funding on this application. See also number 104.
109	Certifications	The school, library, or consortium listed on the FCC Form 471 application will pay the non-discount portion of the costs of the eligible services and/or equipment to the service provider(s).	See number 104.
110	Certifications	The school, library, or consortium listed on the FCC Form 471 application has conducted a fair and open competitive bidding process and has complied with all applicable state, Tribal, or local laws regarding procurement of the equipment and services for which support is being sought.	See number 104.
111	Certifications	An FCC Form 470 was posted and that any related request for proposals (RFP) was made available for at least 28 days before considering all bids received and selecting a service provider. The school, library, or consortium listed on the FCC Form 471 application carefully considered all bids submitted and selected the most-cost-effective bid for services and equipment in accordance with § 54.2005(e), with price being the primary factor considered.	See number 104.
112	Certifications	The school, library, or consortium listed on the FCC Form 471 application is only seeking support for eligible services and/or equipment.	See number 104.
113	Certifications	The school, library, or consortia is not seeking Schools and Libraries Cybersecurity Pilot Program support or reimbursement for the portion of eligible services and/or equipment that have been purchased and reimbursed in full or in part with other federal, state, Tribal, or local funding, or are eligible for discounts from the schools and libraries universal service support mechanism or another universal service support mechanism.	See number 104.
114	Certifications	The services and equipment the school, library, or consortium purchases using Schools and Libraries Cybersecurity Pilot Program support will be used primarily for educational purposes and will not be sold, resold, or transferred in consideration for money or any other thing of value, except as allowed by § 54.2003(b).	See number 104.
115	Certifications	The school, library, or consortium will create and maintain an equipment and service inventory as required by § 54.2010(a).	See number 104.
116	Certifications	The school, library, or consortium has complied with all program rules and acknowledges that failure to do so may result in denial of funding and/or recovery of funding.	See number 104.
117	Certifications	The school, library, or consortium acknowledges that it may be audited pursuant to its application, that it will retain for ten years any and all records related to its application, and that, if audited, it shall produce such records at the request of any representative (including any auditor) appointed by a state education department, the Administrator, the Commission and its Office of Inspector General, or any local, state, or federal agency with jurisdiction over the entity.	See number 104.
118	Certifications	No kickbacks, as defined in 41 U.S.C. § 8701, were paid to or received by the participant, including, but not limited to, their employees, officers, representatives, agents, independent contractors, consultants, family members, and individuals who are on the governing boards, from anyone in connection with the Schools and Libraries Cybersecurity Pilot Program or the schools and libraries universal service support mechanism.	See number 104.
119	Certifications	The school, library, or consortium acknowledges that Commission rules provide that persons who have been convicted of criminal violations or held civilly liable for certain acts arising from their participation in the universal service support mechanisms are subject to suspension and debarment from the program. The school, library, or consortium will institute reasonable measures to be informed, and will notify the Administrator should it be informed or become aware that any of the entities listed on this application, or any person associated in any way with this 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 universal service support mechanisms.	See number 104.
NOTE: The certification below will only be required if needed. If not needed, participants for the Cybersecurity Pilot Program will not be required to complete the certification below. Participants who have not provided an E-Rate FCC Form 486 or FCC Form 479 certifying compliance with the Children’s Internet Protection Act (CIPA) for the current E-Rate program funding year may need to certify compliance with CIPA on the Schools and Libraries Cybersecurity Pilot Program FCC Form 471.
120	CIPA Certifications	I certify that as of the date of the start of Schools and Libraries Cybersecurity Pilot Program supported services: The recipient(s) of service represented in the Funding Request Number(s) on this Form 471 has (have) complied with the requirements of the Children's Internet Protection Act (CIPA), as codified at 47 U.S.C. § 254(h) and (l). The recipient(s) of service represented in the Funding Request Number(s) on this Form 471 is (are) undertaking such actions, including any necessary procurement procedures, to comply with the requirements of CIPA for the next Schools and Libraries Cybersecurity Pilot Program year, but has (have) not completed all requirements of CIPA for this Pilot Program year. The Children's Internet Protection Act, as codified at 47 U.S.C. § 254(h) and (l), does not apply because the recipient(s) of service represented in the Funding Request Number(s) on this Form 471 is (are) not receiving support for Internet access, Internet service, or internal connections under the universal service support mechanism for schools and libraries or Internet access or Internet service through the Schools and Libraries Cybersecurity Pilot Program, or their connected devices do not use Internet access or Internet service funded through the universal service support mechanism for schools and libraries or the Schools and Libraries Cybersecurity Pilot Program.	For participants who are the administrative authority, the authorized person must certify compliance with the Children’s Internet Safety Act (CIPA) by selecting the certification that is applicable.
121	CIPA Certifications	I certify as the Billed Entity for a consortium that as of the date of the start of Schools and Libraries Cybersecurity Pilot Program supported services: That the consortium members represented in the Funding Request Number(s) on this Form 471 have complied with the requirements of the Children's Internet Protection Act (CIPA), as codified at 47 U.S.C. § 254(h) and (l). The consortium members represented in the Funding Request Number(s) on this Form 471 are undertaking such actions, including any necessary procurement procedures, to comply with the requirements of CIPA for the next Schools and Libraries Cybersecurity Pilot Program year, but has (have) not completed all requirements of CIPA for this Pilot Program year. That the Children's Internet Protection Act, as codified at 47 U.S.C. § 254(h) and (l), does not apply because the consortium members represented in the Funding Request Number(s) on this Form 471 are not receiving support for Internet access, Internet service, or internal connections under the universal service support mechanism for schools and libraries or Internet access or Internet service through the Schools and Libraries Cybersecurity Pilot Program, or their connected devices do not use Internet access or Internet service funded through the universal service support mechanism for schools and libraries or the Schools and Libraries Cybersecurity Pilot Program.	For participants who are the Billed Entity for a consortium, the authorized person must certify compliance with the Children’s Internet Safety Act (CIPA) by selecting the certification that is applicable.

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