TRS Fund Annual Provider Filing | DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS | ||||||
The FCC is authorized under the Communications Act of 1934, as amended, to collect the information we request in this form. If we believe there may be a violation or a potential violation of a FCC statute, regulation, rule or order, your certification may be referred to the Federal, state or local agency responsible for investigating, prosecuting, enforcing, or implementing the statute, rule, regulation, or order. In certain cases, the information in your certification may be disclosed to the Department of Justice or a court or adjudicative body when a) the FCC; or b) any employee of the FCC; or c) the United States Government is a party of a proceeding before the body or has an interest in the proceeding. | ||||||
We have estimated that this collection of information will take 10.0 hours annually. Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. 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, Office of Managing Director, AMD-PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060-0463). We will also accept your PRA comments if you send an e-mail to [email protected]. | ||||||
Please DO NOT SEND COMPLETED FORMS 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 and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0463. | ||||||
THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93- 579, DECEMBER 31, 1974, 5 U.S.C. SECTION 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507. | ||||||
TRS Fund Annual Provider Filing Instructions |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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Below are general instructions for completing this filing workbook. For complete instructions, please reference the Annual Filing - Provider Instructions document. Any questions should be submitted to the Rolka Loube Provider Help Desk | ||||||||||||
Rolka Loube Provider Help Desk | ||||||||||||
Worksheet | Instructions | |||||||||||
Filing Information | Use the provided areas to supply provider, filing year, preparer, and attesting officer information. | |||||||||||
Filing Notes | Summarize any service improvements, forecasting methodologies and changes to relay demand. | |||||||||||
Flat Rate Revenue | For TTY, STS, or CTS providers, supply requested data for flat rate service contracts. | |||||||||||
Per Minute Revenue | For TTY, STS, or CTS providers, supply requested data for per minute rate service contracts. | |||||||||||
Add. Revenue Paid To Provider | Supply requested data for revenue received for programs that support TTY, STS, and/or CTS above those associated with provisioning the service (i.e., outreach, billing, administration). | |||||||||||
Add. Costs Paid by Provider | Supply requested data for costs paid for incentives or services for which the state was not required to pay | |||||||||||
Demand | For VRS, IP Relay, IP CTS CA, or IP CTS ASR providers, supply two years of historical and two years of projected demand for each service. | |||||||||||
VRS Expenses | For expenses associated with provisioning the service, supply two years of historical and two years of projected expenses for each category/subcategory. See descriptions of the expense subcategories below. | |||||||||||
IP Relay Expenses | ||||||||||||
IP CTS CA Expenses | ||||||||||||
IP CTS ASR Expenses | ||||||||||||
CA Stats | For all IP-based TRS that require the use of a communications assistant (CA), for all services, supply two years of historical and two years of projected CA employment stats. | |||||||||||
IP Based Expense Categories/Subcategories | ||||||||||||
Category | Subcategory | Description | ||||||||||
A. Annual Recurring Fixed/Semi-Variable Expenses | 1. Rent | Annual payments solely for land and/or buildings rented for the provision of the TRS, including the rent of office space used by administrative employees. | ||||||||||
2. Utilities | Allowable expenses associated with land and buildings used for the provision of the TRS, such as electric power, natural gas, water, sewerage, fuel, T1, trunk lines, Internet connectivity, internet service, and VoIP service. Telephone service expenses, such as center toll-free numbers, and local and foreign exchange should be included here along with related E911 and numbering expenses linked to assigning and porting. Please see appendix instructions for reporting total, allowable, and non-allowable E911 and numbering expenses. | |||||||||||
3. Building Maintenance | Expenses for maintenance and repair used for the provision of the TRS, including maintenance of office buildings. | |||||||||||
4. Property Tax | Real estate taxes paid on property owned and used for the provision of the TRS. | |||||||||||
5. Furniture | Lease or rental expenses associated with furnishings used for the provision of the TRS. | |||||||||||
6. Office Equipment | Lease or rental expenses associated with office equipment used for the provision of the TRS. | |||||||||||
B. Recurring Variable Expenses ( Direct TRS Operation Expenses) | 1. Salaries & Benefits – Relay Center: CA/Interpreting staff | CA and interpreter staff compensation such as wages, salaries, commissions, bonuses, incentive awards, and termination payments; payroll-related benefits paid on behalf of employees, such as pensions, savings plans, workers’ compensation required by law, insurance plans (life, hospital, medical, dental, vision); and social security and other payroll taxes. Include expenses associated with individually contracted or sole proprietor interpreters and CAs. The FCC prohibits incentives paid to CAs and interpreters for the number of calls or the number of minutes billed. | ||||||||||
2. Salaries & Benefits – Relay Center: Management staff | Relay center managers & supervisor compensation such as wages, salaries, commissions, bonuses, incentive awards, and termination payments; payroll-related benefits paid on behalf of employees, such as pensions, savings plans, workers’ compensation required by law, insurance plans (life, hospital, medical, dental, vision); and social security and other payroll taxes. | |||||||||||
3. Salaries & Benefits – Relay Center: Relay Center staff | Relay center staff compensation such as wages, salaries, commissions, bonuses, incentive awards and termination payments; payroll-related benefits paid on behalf of employees, such as pensions, savings plans, workers’ compensation required by law, insurance plans (life, hospital, medical, dental, vision); and social security and other payroll taxes. | |||||||||||
4. Telecommunications Expenses | Expenses associated with inspecting, testing, analyzing and correcting trouble; repairing or reporting on telecommunications plant (switching, transmission, operator, cable, and wire) to determine need for repair, replacements, rearrangements, and changes; expenses for activities, such as controlling traffic flow, administering traffic measuring and monitoring devices, assigning equipment and load balancing, collecting and summarizing traffic data, administering trunking equipment and facilities, automatic call distributor, and assigning interoffice facilities and circuit layout work. | |||||||||||
5. Relay Center Expenses | Expenses not included in other accounts, such as providing food services, libraries, archives, mail service, procuring office equipment, office supplies, materials, and repair. | |||||||||||
C. Administrative Expenses | 1. Accounting/Finance | Expenses incurred in providing accounting and financial services. Accounting services include payroll and disbursements, property accounting, capital recovery, regulatory accounting, tax accounting, auditing, capital and operating budget and control, and general accounting. Financial services include banking operations, cash management, and benefit investment fund management, etc. | ||||||||||
2. Legal/Regulatory | Expenses incurred for legal and regulatory services. Legal services include conducting and coordinating litigation, providing guidance on regulatory and labor matters, court expenses, filing fees, cost of counsel, etc. Regulatory services include preparing and presenting information for regulatory purposes, such as responding to this data request and the cost of registering customers in the User Registration Database (URD). | |||||||||||
3. Engineering | Expenses incurred in the general day-to-day engineering operation of the TRS telecommunications plant and/or IP network. | |||||||||||
4. Research and Development | Expenses incurred for research and development required to meet mandatory minimum standards and, for VRS, IP CTS, and IP Relay, enhanced functional equivalency (e.g. geolocation for 911 calls, direct-dial access to 988 and N11, unified phone number for relay and SMS messaging, integration of VRS with videoconferencing, interoperability improvements, and seamless access across VRS, IP CTS, and IP Relay providers to VRS, IP CTS, and IP Relay from home, work, or mobile devices. Expense to develop proprietary user devices or software or any non-TRS product or service are not recoverable. Please see appendix instructions for reporting total R&D expenses. | |||||||||||
5. Operations Support | Expenses that ensure the sustainability of service including troubleshooting, customer service, and technical support. | |||||||||||
6. Human Resources | Expenses incurred in performing personnel administration activities, including recruiting, hiring, forecasting, planning, training, scheduling, counseling employees, and reporting. | |||||||||||
7. Billing | Administrative expenses of rating and providing billing information to interexchange and local exchange carriers, if not recovered by other means. | |||||||||||
8. Contract Management | Expenses of managing activities required by the provider contracts. | |||||||||||
9. Risk Management | Management expenses associated with workers’ compensation, payments in settlement of accident and damage claims, insurance premiums against losses and damages, sickness, and disability payment, etc. | |||||||||||
10. Other Corporate Overhead | Other administrative expenses of providing TRS. All costs over $10,000 should be itemized. Indirect overhead costs are not reasonable costs of providing TRS Fund supported services. Appropriate overhead costs are those costs that are directly related to and directly support the provision of TRS Fund supported relay service(s). Indirect overhead costs may not be allocated to TRS Fund supported services by an entity that provides other services not supported by the TRS Fund based on the percentage of the entity’s revenues that are derived from the provision of TRS. Backup support is required for all expenses listed in this category. | |||||||||||
11. Enforcement Action Expenses | Expenses incurred to comply with an FCC enforcement action or Consent Decree, as not attributable to the cost of providing TRS and not recoverable from the TRS Fund. Itemized expenses include civil penalties, criminal penalties, fines, recoveries to the Fund, other direct Fund payments, identified in an FCC enforcement action as not being allowable cost. | |||||||||||
D. Depreciation Associated with Capital Investments | 1. Furniture & Fixtures | Depreciation expense on furniture and/or fixtures. | ||||||||||
2. Telecommunications Equipment | Depreciation expense associated with capitalized expenses of telecommunication equipment including switching equipment, operator services equipment, cable and wire facilities, transmission equipment, and power equipment. | |||||||||||
3. Leasehold | Amortization of leasehold improvements – improvements which become a permanent part of a building, like walls or carpeting. | |||||||||||
4. Software | Amortization expenses associated with capitalized software. | |||||||||||
5. Other Capitalized | Depreciation expense not accounted for in other categories such as capitalized R&D. | |||||||||||
E. Other TRS Expenses | 1. Marketing/Advertising Expenses | Expenses associated with promoting provided services and/or identifying the needs of users excluding costs associated with providing user incentives. | ||||||||||
2. Outreach Expenses | Expenses associated with educating the public on the TRS. | |||||||||||
3. Subcontractor | Third-party costs associated with two or more individuals providing IP-based TRS for the provider under a single contract. Please see appendix instructions for reporting and allocating subcontractor costs to the appropriate categories and subcategories. Subcontractor costs not properly allocated shall be treated as non-allowable costs. | |||||||||||
4. License Fees paid to a third party | Expenses associated with payments to a third-party for use of technology, software, and/or equipment. | |||||||||||
5. License Fees paid to an affiliate | Expenses associated with payments to an affiliate for use of technology, software, and/or equipment. | |||||||||||
6. Software | Expenses related to in-house development/maintenance of software and/or license fees associated with commercial software must be used to meet mandatory minimum standards and allow for the provision of functionally equivalent service. Please see appendix instructions for reporting total software expenses including software for off-the-shelf CPE and software expenses. | |||||||||||
7. Customer Premises Equipment | Expenses associated with hardware and software, including installation, maintenance, and testing as well as expenses associated with software installed on proprietary CPE. | |||||||||||
8. Other | Any expenses associated with provisioning TRS that has not been reported previously. Explanation of costs must be included within the appendix. | |||||||||||
F. Capital Investmens | 1. Furniture & Fixtures | Year-end net book value of capital investment on furniture and/or fixtures. | ||||||||||
2. Telecommunications Equipment | Year-end net book value of capital investment associated with telecommunication equipment including switching equipment, operator services equipment, cable and wire facilities, transmission equipment, and power equipment. | |||||||||||
3. Leasehold | Year-end net book value of capital investment of leasehold improvements – improvements which become a permanent part of a building, like walls or carpeting. | |||||||||||
4. Software | Year-end net book value of capital investments associated with capitalized software. Please see appendix instructions for reporting total software expenses including software on off-the-shelf CPE and software expenses above and beyond meeting mandatory minimum standards. | |||||||||||
5. Other Capitalized | Year-end net book value of capital investments not accounted for in other categories. | |||||||||||
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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Data may be entered on the worksheet, or a document may be embedded in the worksheet. Additional worksheets may be added as needed. To assist with reviewing the required appendix data, please identify the worksheet and/or filename that contains the referenced appendix data. Required appendix data is described in the table below. | |||||||||||||
Cost Category/Subcategory and required data | Worksheet/File Name | ||||||||||||
A. Recurring Fixed/Semi-Variable Expenses | |||||||||||||
1) For expenses that are provisioned jointly with the expenses for other telecommunications relay services, provide the following: | |||||||||||||
Total company expenses | |||||||||||||
Description of how the total expenses are allocated among the TRS services and between TRS and non-TRS services | |||||||||||||
Percent allocation for each service | |||||||||||||
2) Seperately identify allowable and non-allowable costs associated with E911 and numbering for IP based TRS for each of the following categories: | |||||||||||||
Ensuring that database information is properly and timely updated and maintained | |||||||||||||
Processing and transmitting calls made to ten-digit numbers | |||||||||||||
Routing emergency calls to an appropriate Public Safety Answering Point | |||||||||||||
Other implementation-related tasks directly related to facilitating ten-digit numbering and emergency call handling | |||||||||||||
Consumer outreach and education related to the requirements and services | |||||||||||||
Any costs associated with obtaining numbers | |||||||||||||
B. Recurring Variable Expenses (Direct TRS Operation Expenses) | |||||||||||||
1) Provide, by call center, at-home status, job descriptions/titles and compensation including salaries and benefits and average number of staff within the following categories: | |||||||||||||
Provider employed CA and/or interpreter staff | |||||||||||||
Provider contracted CA and/or interpreter staff | |||||||||||||
Relay center management and/or supervisors | |||||||||||||
Relay center staff | |||||||||||||
2) Provide contracts for sole proprietor and individually operated LLCs offering CA and interpreter services | |||||||||||||
3) Summarize expenses exceeding $10,000 including vendor, description of goods/services, and expense amounts for the following categories: | |||||||||||||
Telecommunication expenses | |||||||||||||
Relay center expenses | |||||||||||||
C. Administrative Expenses | |||||||||||||
1) Provide job descriptions/titles and compensation including salaries and benefits and average number of staff within the following categories: | |||||||||||||
Finance/Accounting | |||||||||||||
Legal/Regulatory | |||||||||||||
Engineering | |||||||||||||
Research and development – broken down by platform, software, and CPE; research and development expenses required to meet mandatory minimum standards and to enhance functional equivalency shall be broken down into separate amounts. | |||||||||||||
Operations Support | |||||||||||||
Human Resources | |||||||||||||
Billing | |||||||||||||
Contract Management | |||||||||||||
Other Corporate Overhead | |||||||||||||
2) Summarize expenses exceeding $10,000 including vendor, description of goods/services, and expense amounts for the following categories: | |||||||||||||
Finance/Accounting | |||||||||||||
Legal/Regulatory | |||||||||||||
Engineering | |||||||||||||
Research and Development – broken down by platform, software, and CPE; research and development expenses required to meet mandatory minimum standards and to meet functional equivalency shall be broken down into separate amounts. | |||||||||||||
Operations Support | |||||||||||||
Human Resources | |||||||||||||
Contract Management | |||||||||||||
Other Corporate Overhead | |||||||||||||
4) Describe all TRS related engineering projects including projects that are ongoing, planned, recently completed, and cancelled, and to the extent applicable, explain the purpose and intended outcome for the provision of TRS services and how the individual projects preserve or enhance funtional equivalency. VRS providers should furnish the following details |
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Provide a list of all engineering projects that the provider engaged in for each reporting calendar year | |||||||||||||
For each engineering project listed above, provide the goals of the project | |||||||||||||
For each engineering project listed above, provide the dollar amount of expenses spent on that particular project for each reporting calendar year | |||||||||||||
For each engineering project listed above, describe how the completion of the project would affect the provider's VRS offerings | |||||||||||||
For each engineering project listed above, state whether the project was required to meet mandatory minimum standards of enhance functional equivalency. | |||||||||||||
For each engineering project listed above, indicate whether the project affected the provider's platform, software or CPE, and the relationship of the particular project to a specific service that the provider offers. | |||||||||||||
5) Describe all TRS related R&D projects including projects that are ongoing, planned, recently completed, and cancelled, and to the extent applicable, explain the purpose and intended outcome for the provision of TRS services and how the individual projects preserve or enhance funtional equivalency. VRS providers should furnish the following details |
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Provide a list of all R&D projects that the provider engaged in for each reporting calendar year | |||||||||||||
For each R&D project listed above, provide the goals of the project | |||||||||||||
For each R&D project listed above, provide the dollar amount of expenses spent on that particular project for each reporting calendar year | |||||||||||||
For each R&D project listed above, describe how the completion of the project would affect the provider's VRS offerings | |||||||||||||
For each R&D project listed above, state whether the project was required to meet mandatory minimum standards of enhance functional equivalency. | |||||||||||||
For each R&D project listed above, indicate whether the project affected the provider's platform, software or CPE, and the relationship of the particular project to a specific service that the provider offers. | |||||||||||||
6) For VRS providers, provide a detailed breakdown of the allowable and non-allowable Field Staff costs. Allowable costs include the registration of end users, training on the use of non-proprietary devices, and the completion of ports. Non-allowable costs include the installation, maintenance, and training on the use of proprietary CPE. | |||||||||||||
7) Provide other expenses incurred in rating and providing billing information to exchange and interexchange carriers if not recovered by other means. | |||||||||||||
8) Provide a list of officers, senior management, and directors. For individuals listed: | |||||||||||||
Provide a schedule that shows how their compensation has been assigned between TRS and non-TRS services. For TRS services managed by state programs, provide a schedule that shows how their compensation has been assigned between the Interstate and Intrastate components. For interstate Fund supported services, identify separately expenses assigned to each service. | |||||||||||||
Indicate if their compensation has been included in any other cost category/subcategory | |||||||||||||
9) Provide cost details of all Consent Decrees, Judgments, or other legal action that resulted in payments to the Fund, the U.S. Treasury, or a Third-Party to be broken down into separate amounts (e.g. fines, penalties, Fund reimbursements, and any other legal obligations). | |||||||||||||
Provide details of compliance plans for each, where applicable, and any additional costs associated with maintaining adherence to the plan. | |||||||||||||
D. Depreciation Associated with Capital Investment | |||||||||||||
1) Provide the depreciation method and period applied. | |||||||||||||
2) Explain departures from traditional depreciation methods | |||||||||||||
3) Summarize depreciable life, depreciation method, and depreciation expenses by cost subcategory | |||||||||||||
E. Other TRS Expenses | |||||||||||||
1) Provide job descriptions/titles and compensation including salaries and benefits and average number of staff within the following categories: | |||||||||||||
Marketing/Advertising | |||||||||||||
Outreach | |||||||||||||
Customer Premise Equipment - sales, installation, and maintenance employees | |||||||||||||
2) For expenses exceeding $10,000, provide vendor, description of goods/services, and expense amounts for the following categories: | |||||||||||||
Marketing/Advertising | |||||||||||||
Outreach | |||||||||||||
Subcontractor | |||||||||||||
3) For all outreach activities and/or projects directly relating to the provision of TRS services | |||||||||||||
The number of activities and/or projects | |||||||||||||
A description of the activity and/or project, specify whether the project was for interstate and/or intrastate services. If jointly, how allocated and specify the allocation method for each services's activity and/or project. | |||||||||||||
Annual expense amount recorded for the relevant outreach activities and/or projects. | |||||||||||||
4) Provide a copy of each subcontractor contract and include contract termination dates, billing rates and billing units, and an allocation of subcontractor expenses by RSDR expense categories and subcategories. Include all data that supports the allocation of subcontractor expenses. | |||||||||||||
5) Provide a list of items purchased and outline billing rates and biling units for the following categories | |||||||||||||
License fees paid to a third party | |||||||||||||
License fees paid to an affiliate | |||||||||||||
6) Provide the number of Customer Premises Equipment sold, produced, and installed. | |||||||||||||
7) Provide the costs of CPE provided to consumers. Provide a schedule that breaks out the expenses among its component parts. | |||||||||||||
8) Provide a schedule of software expenses associated with CPE. Identify separately software expenses related to proprietary CPE and off-the-shelf CPE. Software expenses required to meet mandatory minimum standards and software expenses above and beyond meeting mandatory minimum standards shall be broken down into separate amounts. | |||||||||||||
9) Provide a schedule identifying and describing any expenses not previously reported in another category. | |||||||||||||
F. Capital Investments | |||||||||||||
1) Provide an account of all capital equipment purchased in order to provide each form of TRS. Only include capital investment items that are long term in nature and subject to depreciation. Items such as office supplies should be listed in Section B6. | |||||||||||||
Itemize investments by: Form of TRS, Equipment class, Gross book values, Accumulated depreciation, Net book values | |||||||||||||
For equipment used to monitor and supervise call centers that provide multiple TRS services, provide the total company investments, describe how total investments are allocated among the services, and the percent allocation for each service | |||||||||||||
2) Provide an account of all capitalized expenses associated with software installed on off-the-shelf CPE and capitalized expenses associated with software installed on proprietary CPE shall be broken down into separate amounts. Capitalized expenses associated with software installed on CPE required to preserve or enhance functional equivalency and capitalized expenses associated with software installed on CPE required to preserve or enhance functional equivalency shall be broken down into separate amounts. | |||||||||||||
TRS Fund Annual Provider Filing | DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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Provider Name | |||||||||||
Preparer Name | |||||||||||
Preparer's Email Address | |||||||||||
Preparer's Telephone | |||||||||||
Filing Period | 2024 | ||||||||||
Signed By: | |||||||||||
Senior Officer Name | |||||||||||
Senior Officer Title | |||||||||||
I swear under penalty of perjury that I am _______________________, __________________________, an officer of the above-named reporting entity and that I have examined the foregoing reports and that all requested information has been provided and all statements of fact, are true and accurate. | |||||||||||
Persons willfully making false statements on this form can be punished by fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. §1001. | |||||||||||
Date | |||||||||||
Signature | |||||||||||
TRS Fund Annual Provider Filing | DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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To assist RolkaLoube in understanding your data, please provide the following information: | |||||||||||
Provide a summary of any changes, activities, and/or improvements since the prior year filing or that are planned for the upcoming program year, which caused or may cause substantial changes in cost and/or demand data. | |||||||||||
Describe the methology used to determine the forecasted minutes for the projected years. | |||||||||||
Describe any characteristics unique to a particular service or changes in the relay services marketplace. | |||||||||||
TRS Fund Annual Provider Filing Flat Rate Revenue |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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For each state for which the provider provides TTY, STS, and/or CTS service at a flat rate, supply the following information associated with provision of service minutes. | ||||||||||||||
Jurisdiction | Rate Covers Services | Rate Start | Rate End | Reported as Annual Total or Monthly Rate | Flat Rate Amount | Conversation Minutes Serviced During Rate Period | ||||||||
TTY | STS | CTS | TTY | STS | CTS |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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For each state for which the provider provides TTY, STS, and/or CTS service at a per minute rate, supply the following information. | |||||||||||
Jurisdiction | Service | Rate Start | Rate End | Per Session or Conversation Minute | Per Minute Rate | Minutes Serviced During Rate Period | |||||
Conversation | Session |
TRS Fund Annual Provider Filing Additional Costs Paid To Provider |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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For each state for which the provider provides TTY, STS, and/or CTS service and received funds above those related to provision service minutes, supply the following information. | ||||||||||||||
Jurisdiction | Add. Revenue Covers | Revenue Start | Revenue End | Reported as Annual Total or Monthly Cost | Amount | Program | Other Description | |||||||
TTY | STS | CTS | ||||||||||||
TRS Fund Annual Provider Filing Costs Paid By Provider |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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For each state for which the provider provides TTY, STS, and/or CTS service and for which the provider paid for incentives or services the state was not required to pay for, supply the following information. | |||||||||||||
Jurisdiction | Cost Covers | Cost Start | Cost End | Reported as Annual Total or Monthly Cost | Amount | Description | |||||||
TTY | STS | CTS |
TRS Fund Annual Provider Filing IP Based Service Provider Demand |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
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For each IP based service provided by the provider, please supply two years of actual compensated demand and two years of projected compensable demand for the years listed below. | ||||||||||||||
VRS | Actuals | Projections | IP Relay | Actuals | Projections | |||||||||
2023 | 2024 | 2025 | 2026 | 2023 | 2024 | 2025 | 2026 | |||||||
January | 0 | 0 | 0 | 0 | January | 0 | 0 | 0 | 0 | |||||
February | 0 | 0 | 0 | 0 | February | 0 | 0 | 0 | 0 | |||||
March | 0 | 0 | 0 | 0 | March | 0 | 0 | 0 | 0 | |||||
April | 0 | 0 | 0 | 0 | April | 0 | 0 | 0 | 0 | |||||
May | 0 | 0 | 0 | 0 | May | 0 | 0 | 0 | 0 | |||||
June | 0 | 0 | 0 | 0 | June | 0 | 0 | 0 | 0 | |||||
July | 0 | 0 | 0 | 0 | July | 0 | 0 | 0 | 0 | |||||
August | 0 | 0 | 0 | 0 | August | 0 | 0 | 0 | 0 | |||||
September | 0 | 0 | 0 | 0 | September | 0 | 0 | 0 | 0 | |||||
October | 0 | 0 | 0 | 0 | October | 0 | 0 | 0 | 0 | |||||
November | 0 | 0 | 0 | 0 | November | 0 | 0 | 0 | 0 | |||||
December | 0 | 0 | 0 | 0 | December | 0 | 0 | 0 | 0 | |||||
Totals | - | - | - | - | Totals | - | - | - | - | |||||
IP CTS CA | Actuals | Projections | IP CTS ASR | Actuals | Projections | |||||||||
2023 | 2024 | 2025 | 2026 | 2023 | 2024 | 2025 | 2026 | |||||||
January | 0 | 0 | 0 | 0 | January | 0 | 0 | 0 | 0 | |||||
February | 0 | 0 | 0 | 0 | February | 0 | 0 | 0 | 0 | |||||
March | 0 | 0 | 0 | 0 | March | 0 | 0 | 0 | 0 | |||||
April | 0 | 0 | 0 | 0 | April | 0 | 0 | 0 | 0 | |||||
May | 0 | 0 | 0 | 0 | May | 0 | 0 | 0 | 0 | |||||
June | 0 | 0 | 0 | 0 | June | 0 | 0 | 0 | 0 | |||||
July | 0 | 0 | 0 | 0 | July | 0 | 0 | 0 | 0 | |||||
August | 0 | 0 | 0 | 0 | August | 0 | 0 | 0 | 0 | |||||
September | 0 | 0 | 0 | 0 | September | 0 | 0 | 0 | 0 | |||||
October | 0 | 0 | 0 | 0 | October | 0 | 0 | 0 | 0 | |||||
November | 0 | 0 | 0 | 0 | November | 0 | 0 | 0 | 0 | |||||
December | 0 | 0 | 0 | 0 | December | 0 | 0 | 0 | 0 | |||||
Totals | - | - | - | - | Totals | - | - | - | - | |||||
TRS Fund Annual Provider Filing VRS Expense and Capital Investment Data |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
|||||||||
For expenses associated with the provisioning of VRS service, provide two years of actual and two years of projected expenses for each category/subcategory. | ||||||||||
Actuals | Projections | |||||||||
2023 | 2024 | 2025 | 2026 | |||||||
A. Recurring Fixed/Semi-Variable Expenses | ||||||||||
1 | 1. Rent | $- | $- | $- | $- | |||||
2 | 2. Utilities | $- | $- | $- | $- | |||||
3 | 3. Building Maintenance | $- | $- | $- | $- | |||||
4 | 4. Property Tax (if owned) | $- | $- | $- | $- | |||||
5 | 5. Furniture (if leased) | $- | $- | $- | $- | |||||
6 | 6. Office Equipment ( if leased) | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
B. Recurring Variable Expenses (Direct TRS Operation Expenses) | ||||||||||
7 | 1. Salaries & Benefits - Relay Center: CA/Interpreting Staff | $- | $- | $- | $- | |||||
8 | 2. Salaries & Benefits - Relay Center: Management | $- | $- | $- | $- | |||||
9 | 3. Salaries & Benefits - Relay Center Staff | $- | $- | $- | $- | |||||
10 | 4. Telecommunication Expenses | $- | $- | $- | $- | |||||
11 | 5. Relay Center Expenses | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
C. Administrative Expenses | ||||||||||
12 | 1. Accounting/Finance | $- | $- | $- | $- | |||||
13 | 2. Legal/Regulatory | $- | $- | $- | $- | |||||
3. Engineering | $- | $- | $- | $- | ||||||
14 | 4. Research and Development | $- | $- | $- | $- | |||||
15 | 5. Operations Support | $- | $- | $- | $- | |||||
16 | 6. Human Resources | $- | $- | $- | $- | |||||
17 | 7. Billing | $- | $- | $- | $- | |||||
18 | 8. Contract Management | $- | $- | $- | $- | |||||
19 | 9. Risk Management | $- | $- | $- | $- | |||||
20 | 10. Other Corporate Overheads | $- | $- | $- | $- | |||||
21 | 11. Enforcement Action Expenses | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
D. Depreciation Associated With Capital Investment | ||||||||||
22 | 1. Furniture & Fixtures | $- | $- | $- | $- | |||||
23 | 2. Telecommunications Equipment | $- | $- | $- | $- | |||||
24 | 3. Leasehold | $- | $- | $- | $- | |||||
25 | 4. Software | $- | $- | $- | $- | |||||
26 | 5. Other Capitalized | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
E. Other TRS Expenses | ||||||||||
27 | 1. Marketing/Advertising Expenses | $- | $- | $- | $- | |||||
28 | 2. Outreach Expenses | $- | $- | $- | $- | |||||
29 | 3. Subcontractor Expenses excluding License Fees | $- | $- | $- | $- | |||||
30 | 4. License Fees paid to a third party | $- | $- | $- | $- | |||||
31 | 5. License Fees paid to an affiliate | $- | $- | $- | $- | |||||
32 | 6. Software | $- | $- | $- | $- | |||||
33 | 7. Customer Premise Equipment | $- | $- | $- | $- | |||||
34 | 8. Other | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
F. Capital Investments | ||||||||||
35 | 1. Furniture & Fixtures | $- | $- | $- | $- | |||||
36 | 2. Telecommunications Equipment | $- | $- | $- | $- | |||||
37 | 3. Leasehold | $- | $- | $- | $- | |||||
38 | 4. Software | $- | $- | $- | $- | |||||
39 | 5. Other Capitalized | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
TRS Fund Annual Provider Filing IP Relay Expense and Capital Investment Data |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
|||||||||
For expenses associated with the provisioning of IP Relay service, provide two years of actual and two years of projected expenses for each category/subcategory. | ||||||||||
Actuals | Projections | |||||||||
2023 | 2024 | 2025 | 2026 | |||||||
A. Recurring Fixed/Semi-Variable Expenses | ||||||||||
1 | 1. Rent | $- | $- | $- | $- | |||||
2 | 2. Utilities | $- | $- | $- | $- | |||||
3 | 3. Building Maintenance | $- | $- | $- | $- | |||||
4 | 4. Property Tax (if owned) | $- | $- | $- | $- | |||||
5 | 5. Furniture (if leased) | $- | $- | $- | $- | |||||
6 | 6. Office Equipment ( if leased) | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
B. Recurring Variable Expenses (Direct TRS Operation Expenses) | ||||||||||
7 | 1. Salaries & Benefits - Relay Center: CA/Interpreting Staff | $- | $- | $- | $- | |||||
8 | 2. Salaries & Benefits - Relay Center: Management | $- | $- | $- | $- | |||||
9 | 3. Salaries & Benefits - Relay Center Staff | $- | $- | $- | $- | |||||
10 | 4. Telecommunication Expenses | $- | $- | $- | $- | |||||
11 | 5. Relay Center Expenses | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
C. Administrative Expenses | ||||||||||
12 | 1. Accounting/Finance | $- | $- | $- | $- | |||||
13 | 2. Legal/Regulatory | $- | $- | $- | $- | |||||
3. Engineering | $- | $- | $- | $- | ||||||
14 | 4. Research and Development | $- | $- | $- | $- | |||||
15 | 5. Operations Support | $- | $- | $- | $- | |||||
16 | 6. Human Resources | $- | $- | $- | $- | |||||
17 | 7. Billing | $- | $- | $- | $- | |||||
18 | 8. Contract Management | $- | $- | $- | $- | |||||
19 | 9. Risk Management | $- | $- | $- | $- | |||||
20 | 10. Other Corporate Overheads | $- | $- | $- | $- | |||||
21 | 11. Enforcement Action Expenses | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
D. Depreciation Associated With Capital Investment | ||||||||||
22 | 1. Furniture & Fixtures | $- | $- | $- | $- | |||||
23 | 2. Telecommunications Equipment | $- | $- | $- | $- | |||||
24 | 3. Leasehold | $- | $- | $- | $- | |||||
25 | 4. Software | $- | $- | $- | $- | |||||
26 | 5. Other Capitalized | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
E. Other TRS Expenses | ||||||||||
27 | 1. Marketing/Advertising Expenses | $- | $- | $- | $- | |||||
28 | 2. Outreach Expenses | $- | $- | $- | $- | |||||
29 | 3. Subcontractor Expenses excluding License Fees | $- | $- | $- | $- | |||||
30 | 4. License Fees paid to a third party | $- | $- | $- | $- | |||||
31 | 5. License Fees paid to an affiliate | $- | $- | $- | $- | |||||
32 | 6. Software | $- | $- | $- | $- | |||||
33 | 7. Customer Premise Equipment | $- | $- | $- | $- | |||||
34 | 8. Other | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
F. Capital Investments | ||||||||||
35 | 1. Furniture & Fixtures | $- | $- | $- | $- | |||||
36 | 2. Telecommunications Equipment | $- | $- | $- | $- | |||||
37 | 3. Leasehold | $- | $- | $- | $- | |||||
38 | 4. Software | $- | $- | $- | $- | |||||
39 | 5. Other Capitalized | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
TRS Fund Annual Provider Filing IP CTS CA Expense and Capital Investment Data |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
|||||||||
For expenses associated with the provisioning of IP CTS CA service, provide two years of actual and two years of projected expenses for each category/subcategory. | ||||||||||
Actuals | Projections | |||||||||
2023 | 2024 | 2025 | 2026 | |||||||
A. Recurring Fixed/Semi-Variable Expenses | ||||||||||
1 | 1. Rent | $- | $- | $- | $- | |||||
2 | 2. Utilities | $- | $- | $- | $- | |||||
3 | 3. Building Maintenance | $- | $- | $- | $- | |||||
4 | 4. Property Tax (if owned) | $- | $- | $- | $- | |||||
5 | 5. Furniture (if leased) | $- | $- | $- | $- | |||||
6 | 6. Office Equipment ( if leased) | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
B. Recurring Variable Expenses (Direct TRS Operation Expenses) | ||||||||||
7 | 1. Salaries & Benefits - Relay Center: CA/Interpreting Staff | $- | $- | $- | $- | |||||
8 | 2. Salaries & Benefits - Relay Center: Management | $- | $- | $- | $- | |||||
9 | 3. Salaries & Benefits - Relay Center Staff | $- | $- | $- | $- | |||||
10 | 4. Telecommunication Expenses | $- | $- | $- | $- | |||||
11 | 5. Relay Center Expenses | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
C. Administrative Expenses | ||||||||||
12 | 1. Accounting/Finance | $- | $- | $- | $- | |||||
13 | 2. Legal/Regulatory | $- | $- | $- | $- | |||||
3. Engineering | $- | $- | $- | $- | ||||||
14 | 4. Research and Development | $- | $- | $- | $- | |||||
15 | 5. Operations Support | $- | $- | $- | $- | |||||
16 | 6. Human Resources | $- | $- | $- | $- | |||||
17 | 7. Billing | $- | $- | $- | $- | |||||
18 | 8. Contract Management | $- | $- | $- | $- | |||||
19 | 9. Risk Management | $- | $- | $- | $- | |||||
20 | 10. Other Corporate Overheads | $- | $- | $- | $- | |||||
21 | 11. Enforcement Action Expenses | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
D. Depreciation Associated With Capital Investment | ||||||||||
22 | 1. Furniture & Fixtures | $- | $- | $- | $- | |||||
23 | 2. Telecommunications Equipment | $- | $- | $- | $- | |||||
24 | 3. Leasehold | $- | $- | $- | $- | |||||
25 | 4. Software | $- | $- | $- | $- | |||||
26 | 5. Other Capitalized | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
E. Other TRS Expenses | ||||||||||
27 | 1. Marketing/Advertising Expenses | $- | $- | $- | $- | |||||
28 | 2. Outreach Expenses | $- | $- | $- | $- | |||||
29 | 3. Subcontractor Expenses excluding License Fees | $- | $- | $- | $- | |||||
30 | 4. License Fees paid to a third party | $- | $- | $- | $- | |||||
31 | 5. License Fees paid to an affiliate | $- | $- | $- | $- | |||||
32 | 6. Software | $- | $- | $- | $- | |||||
33 | 7. Customer Premise Equipment | $- | $- | $- | $- | |||||
34 | 8. Other | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
F. Capital Investments | ||||||||||
35 | 1. Furniture & Fixtures | $- | $- | $- | $- | |||||
36 | 2. Telecommunications Equipment | $- | $- | $- | $- | |||||
37 | 3. Leasehold | $- | $- | $- | $- | |||||
38 | 4. Software | $- | $- | $- | $- | |||||
39 | 5. Other Capitalized | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
TRS Fund Annual Provider Filing IP CTS ASR Expense and Capital Investment Data |
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
|||||||||
For expenses associated with the provisioning of IP CTS ASR service, provide two years of actual and two years of projected expenses for each category/subcategory. | ||||||||||
Actuals | Projections | |||||||||
2023 | 2024 | 2025 | 2026 | |||||||
A. Recurring Fixed/Semi-Variable Expenses | ||||||||||
1 | 1. Rent | $- | $- | $- | $- | |||||
2 | 2. Utilities | $- | $- | $- | $- | |||||
3 | 3. Building Maintenance | $- | $- | $- | $- | |||||
4 | 4. Property Tax (if owned) | $- | $- | $- | $- | |||||
5 | 5. Furniture (if leased) | $- | $- | $- | $- | |||||
6 | 6. Office Equipment ( if leased) | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
B. Recurring Variable Expenses (Direct TRS Operation Expenses) | ||||||||||
7 | 1. Salaries & Benefits - Relay Center: CA/Interpreting Staff | $- | $- | $- | $- | |||||
8 | 2. Salaries & Benefits - Relay Center: Management | $- | $- | $- | $- | |||||
9 | 3. Salaries & Benefits - Relay Center Staff | $- | $- | $- | $- | |||||
10 | 4. Telecommunication Expenses | $- | $- | $- | $- | |||||
11 | 5. Relay Center Expenses | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
C. Administrative Expenses | ||||||||||
12 | 1. Accounting/Finance | $- | $- | $- | $- | |||||
13 | 2. Legal/Regulatory | $- | $- | $- | $- | |||||
3. Engineering | $- | $- | $- | $- | ||||||
14 | 4. Research and Development | $- | $- | $- | $- | |||||
15 | 5. Operations Support | $- | $- | $- | $- | |||||
16 | 6. Human Resources | $- | $- | $- | $- | |||||
17 | 7. Billing | $- | $- | $- | $- | |||||
18 | 8. Contract Management | $- | $- | $- | $- | |||||
19 | 9. Risk Management | $- | $- | $- | $- | |||||
20 | 10. Other Corporate Overheads | $- | $- | $- | $- | |||||
21 | 11. Enforcement Action Expenses | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
D. Depreciation Associated With Capital Investment | ||||||||||
22 | 1. Furniture & Fixtures | $- | $- | $- | $- | |||||
23 | 2. Telecommunications Equipment | $- | $- | $- | $- | |||||
24 | 3. Leasehold | $- | $- | $- | $- | |||||
25 | 4. Software | $- | $- | $- | $- | |||||
26 | 5. Other Capitalized | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
E. Other TRS Expenses | ||||||||||
27 | 1. Marketing/Advertising Expenses | $- | $- | $- | $- | |||||
28 | 2. Outreach Expenses | $- | $- | $- | $- | |||||
29 | 3. Subcontractor Expenses excluding License Fees | $- | $- | $- | $- | |||||
30 | 4. License Fees paid to a third party | $- | $- | $- | $- | |||||
31 | 5. License Fees paid to an affiliate | $- | $- | $- | $- | |||||
32 | 6. Software | $- | $- | $- | $- | |||||
33 | 7. Customer Premise Equipment | $- | $- | $- | $- | |||||
34 | 8. Other | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
F. Capital Investments | ||||||||||
35 | 1. Furniture & Fixtures | $- | $- | $- | $- | |||||
36 | 2. Telecommunications Equipment | $- | $- | $- | $- | |||||
37 | 3. Leasehold | $- | $- | $- | $- | |||||
38 | 4. Software | $- | $- | $- | $- | |||||
39 | 5. Other Capitalized | $- | $- | $- | $- | |||||
Total | $- | $- | $- | $- | ||||||
DRAFT - NOT FOR PUBLIC USE Not Approved By OMB TRS Fund Provider Form Jan 2025 Version OMB Control Number 3060-0463 Estimated Average Burden Hours Per Response: 10.0 Hours |
|||||||||
Please provide data listed below for each service for all CAs employed during the year. | |||||||||
Actuals | Projections | ||||||||
VRS | 2023 | 2024 | 2025 | 2026 | |||||
Average Monthly Full Time CAs | 0 | 0 | 0 | 0 | |||||
Average Monthly Part Time CAs - On Full Time Equivalent Basis | 0 | 0 | 0 | 0 | |||||
Total CA Managers | 0 | 0 | 0 | 0 | |||||
Total Non CA Relay Staff | 0 | 0 | 0 | 0 | |||||
Total Yearly Number of Available Interpreting Minutes | 0 | 0 | 0 | 0 | |||||
Total Yearly Number of Session Minutes | 0 | 0 | 0 | 0 | |||||
Total Yearly Number of Conversation Minutes | 0 | 0 | 0 | 0 | |||||
Occupancy Percentage | 0% | 0% | 0% | 0% | |||||
Utilization Percentage | 0% | 0% | 0% | 0% | |||||
IP Relay | 2023 | 2024 | 2025 | 2026 | |||||
Average Monthly Full Time CAs | 0 | 0 | 0 | 0 | |||||
Average Monthly Part Time CAs - On Full Time Equivalent Basis | 0 | 0 | 0 | 0 | |||||
Total CA Managers | 0 | 0 | 0 | 0 | |||||
Total Non CA Relay Staff | 0 | 0 | 0 | 0 | |||||
Total Yearly Number of Available Interpreting Minutes | 0 | 0 | 0 | 0 | |||||
Total Yearly Number of Session Minutes | 0 | 0 | 0 | 0 | |||||
Total Yearly Number of Conversation Minutes | 0 | 0 | 0 | 0 | |||||
Occupancy Percentage | 0% | 0% | 0% | 0% | |||||
Utilization Percentage | 0% | 0% | 0% | 0% | |||||
IP CTS CA | 2023 | 2024 | 2025 | 2026 | |||||
Average Monthly Full Time CAs | 0 | 0 | 0 | 0 | |||||
Average Monthly Part Time CAs - On Full Time Equivalent Basis | 0 | 0 | 0 | 0 | |||||
Total CA Managers | 0 | 0 | 0 | 0 | |||||
Total Non CA Relay Staff | 0 | 0 | 0 | 0 | |||||
Total Yearly Number of Available Interpreting Minutes | 0 | 0 | 0 | 0 | |||||
Total Yearly Number of Session Minutes | 0 | 0 | 0 | 0 | |||||
Total Yearly Number of Conversation Minutes | 0 | 0 | 0 | 0 | |||||
Occupancy Percentage | 0% | 0% | 0% | 0% | |||||
Utilization Percentage | 0% | 0% | 0% | 0% | |||||
File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |