Form FCC Form 473 FCC Form 473 Service Provider Annual Certification

OMB Control No. 3060-0856 Estimated Time per Response

[Month] 2025 2 hours

Not Yet Approved by OMB

Schools and Libraries Universal Service Program

Service Provider Annual Certification Form 473

(Note: This is a representative description of the information to be collected electronically. This table is not a visual representation of what service providers will see when they use the online FCC Form 473).

	Form 473	Field	Rules
	Service Provider Annual Certification Form
	Block 1: Service Provider Information
	Name of Service Provider	1	Must be entered using alphabetic characters
	Service Provider Identification Number (SPIN)	2	Must be entered using a valid nine digit SPIN number (1430XXXX)
	Funding Year:	3	Must be entered using numeric character in the year format (YYYY)
	Contact Name	4	Must be entered using alphabetic characters
	Complete Mailing Address of Contact Person Street Address, P. O. Box or Route Number	5	Must be entered using alphanumeric characters
	City		Must be entered using alphabetic characters
	State		Must be entered using alphabetic characters
	Zip		Must be entered using alphabetic characters
	Telephone Number with Area Code	6	Must be entered using numeric characters, must be nine digits (xxx-xxx-xxxx)
	Fax Number with Area Code	7	Must be entered using numeric characters, must be nine digits (xxx-xxx-xxxx)
	Email Address	8	Valid email address must be entered. Email must be composed of a username and domain name ([email protected])
	Block 2: Certification
	Signature of authorized person	9	Must be entered using alphabetic characters
	Date	10	Must be entered using numeric characters in the dd/yyyy format.
	Printed name of authorized person	11	Must be entered using alphabetic characters
	Title or position of authorized person	12	Must be entered using alphabetic characters
	Telephone number of authorized person	13	Must be entered using numeric characters, must be nine digits (xxx-xxx-xxxx)
	Address of authorized person	14	Must be entered using alphanumeric characters
	CERTIFICATIONS: I declare under penalty of perjury that the foregoing is true and correct: I am authorized to submit this Service Provider Annual Certification Form on behalf of the above-named Service Provider, which has been assigned the above-referenced Service Provider Identification Number, 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 Form has been examined and reviewed and is true, accurate and complete. I acknowledge that any false statement on this Form or on the Service Provider Invoice Form (FCC Form 474) 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 that any such false statement could subject this Service Provider to liability under the False Claims Act. I certify that the Service Provider Invoice Forms (FCC Form 474) that are submitted by this Service Provider contain requests for universal service support for services which have been billed to the Service Provider’s customers on behalf of schools, libraries, and consortia of those entities, as deemed eligible for universal service support by the Administrator. I certify that the Service Provider Invoice Forms (FCC Form 474) that are submitted by this Service Provider are based on bills or invoices issued by the Service Provider to the Service Provider’s customers on behalf of schools, libraries, and consortia of those entities as deemed eligible for universal service support by the Administrator, and exclude any charges previously invoiced to the Administrator for which the Administrator has not yet issued a reimbursement decision. I certify that the bills or invoices issued by this Service Provider to the Billed Entity are for equipment and services eligible for universal service support by the Administrator, and exclude any charges previously invoiced to the Administrator by the Service Provider. I certify that this Service Provider permits the Billed Entity/Applicant to choose the method of payment for the discounted services from those methods approved by the Administrator as set forth in 47 C.F.R. § 54.514(c). I certify that any requests for reimbursement that are sought under a Service Provider Invoice Form (FCC Form 474) for discounts for products or services that contain both eligible and ineligible components are properly allocated as required by the Commission’s rules at 47 C.F.R. § 54.504(e). I certify that the invoices that are submitted by this Service Provider to the Billed Entity for reimbursement pursuant to Billed Entity Applicant Reimbursement Forms (FCC Form 472) are accurate and represent payments from the Billed Entity to the Service Provider for equipment and services provided pursuant to schools and libraries universal service program rules. I certify that this Service Provider makes available to customers, upon their request, separate prices for distinct services to assist Billed Entity Applicants in identifying the portions of their bills that represent the costs of services provided to eligible entities for eligible purposes. I certify that no non-discount portion of the costs for eligible services will be waived, paid, or promised to be paid by this Service Provider. I acknowledge that an eligible school, library, or consortium may not receive rebates for service or products purchased with universal service support and the provision by any service provider of a supported service or product, or of free services or products unrelated to the supported service or product constitutes a rebate of the non-discount portion of the supported services or product as stated in 47 C.F.R. § 54.523. I certify that no kickbacks, as defined in 41 U.S.C. § 8701, were paid by this Service Provider to anyone in connection with the schools and libraries universal service program. I certify that this Service Provider is in compliance with the Commission’s rule and orders regarding gifts and this Service Provider and has not directly or indirectly offered or provided any gifts, gratuities, favors, entertainment, loans, or any other thing of value to any eligible schools, libraries, or consortium that includes eligible schools or libraries, except as permitted by the Commission’s rule at 47 C.F.R. § 54.503(d). I certify that if the Administrator, as necessary, requests additional supporting information, this Service Provider will make all documents requested available to the Administrator as required by 47 C.F.R. § 54.516(b). I certify that this Service Provider will retain for at least 10 years (or whatever retention period is required by the Commission’s rules in effect at the time of this certification), after the latter of the last day of the applicable funding year or the service delivery deadline for the funding requests, (1) any and all records that I rely upon to complete this form and each Service Provider Invoice Form (FCC Form 474) that is submitted by this Service Provider during the present funding year, (2) any and all records issued by this Service Provider to the Billed Entity for reimbursement pursuant to Billed Entity Applicant Reimbursement Forms (FCC Form 472), and (3) all documents necessary to demonstrate compliance with the statutory or regulatory requirements for the schools and libraries universal service support program as required by 47 C.F.R. § 54.516(a)(2). I acknowledge that this Service Provider may be audited pursuant to 47 C.F.R. § 54.516(c), and that the Service Provider must provide such records as required by 47 C.F.R. § 54.516(b) I certify that the prices in any offer that this Service Provider makes pursuant to the schools and libraries universal service support program have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other offeror or competitor relating to (i) those prices, (ii) the intention to submit an offer, or (iii) the methods or factors used to calculate the prices offered. I certify that the prices in any offer that this Service Provider makes pursuant to the schools and libraries universal service support program will not be knowingly disclosed by this Service Provider, directly or indirectly, to any other offeror or competitor before bid opening (in the case of a sealed bid solicitation) or contract award (in the case of a negotiated solicitation) unless otherwise required by law. I certify that no attempt will be made by this Service Provider to induce any other concern to submit or not to submit an offer for the purpose of restricting competition. I certify that this Service Provider is not suspended or debarred from participating in Federal programs. I certify that, in addition to the foregoing, this Service Provider is in compliance with the rules and orders governing the schools and libraries universal service support program, and acknowledges that failure to be in compliance and remain in compliance with those rules and orders may result in the denial of discount funding and/or cancellation of funding commitments. I acknowledge that failure to comply with the rules and orders governing the schools and libraries universal service program could result in civil or criminal prosecution by law enforcement authorities. I certify that no universal service support has been or will be used to purchase, obtain, maintain, improve, modify, or otherwise support any equipment or services produced or provided by any company designated by the Federal Communications Commission as posing a national security threat to the integrity of communications networks or the communications supply chain since the effective date of the designations. I certify that no Federal subsidy made available through a program administered by the Commission that provides funds to be used for the capital expenditures necessary for the provision of advanced communications services has been or will be used to purchase, rent, lease, or otherwise obtain, any covered communications equipment or service, or maintain any covered communications equipment or service previously purchased, rented, leased, or otherwise obtained, as required by 47 C.F.R. § 54.10. The Service Provider is not seeking duplicative funding or support from the schools and libraries universal service program for eligible services or products that have been funded or paid for by other sources. For off-premises Wi-Fi hotspots and services, I certify that at least once every 31 days, this Service Provider will identify lines of hotspot service that have gone unused for 60 consecutive days and provide applicants 30 days’ notice to use the hotspot before the line of service is terminated. This Service Provider certifies that it will comply with such non-usage notice and termination requirements and will not charge for the balance for terminated services. For off-premises Wi-Fi hotspots and services, the Service Provider certifies that the costs of the Wi-Fi hotspots and services do not exceed commercial value.