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Telecommunications Reporting Worksheet
ICR 202611-3060-007 · OMB 3060-0855 · Object 174470900.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Telecommunications Reporting Worksheet |
| Author | Conor O'Donovan |
| Last Modified By | Writer |
| File Modified | 2026-11-03 |
| File Created | 2026-11-04 |
| Conversion State | complete |
Extracted Text
2027 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2026 Revenues) NOT APPROVED BY OMB 3060-0855 >>> Please read instructions before completing.<<< Annual Filing -- due April 1, 2027 Block 1: Contributor Identification Information During the year, filers must refile Blocks 1, 2 and 6 if there are any changes in Lines 104 or 112. See Instructions. 101 Filer 499 ID [If you don't know your number, contact the administrator at (888) 641-8722. If you are a new filer, write “NEW” in this block and a Filer 499 ID will be assigned to you.] 102 Legal name of filer 103 IRS employer identification number [Enter 9 digit number] 104 Name filer is doing business as 105 Telecommunications activities of filer [Select up to 5 boxes that best describe the reporting entity. Enter numbers starting with “1” to show the order of importance -- see instructions.] Audio Bridging (teleconferencing) Provider CAP/CLEC Cellular/PCS/SMR (wireless telephony inc. by resale) Coaxial Cable Incumbent LEC Interconnected VoIP Interexchange Carrier (IXC) Local Reseller Non-Interconnected VoIP Operator Service Provider Paging Payphone Service Provider Prepaid Card Private Service Provider Satellite Service Provider Shared-Tenant Service Provider / Building LEC SMR (dispatch) Toll Reseller Wireless Data Other Local Other Mobile Other Toll If Other Local, Other Mobile or Other Toll is checked describe carrier type / services provided: 106.1 Affiliated Filers Name/Holding Company Name (All affiliated companies must show the same name on this line.) Check if filer has no affiliates 106.2 Affiliated Filers Name/Holding Company Name IRS employer identification number [Enter 9 digit number] 107 FCC Registration Number (FRN) [https://apps.fcc.gov/cores/userLogin.do] [For assistance, contact the CORES help desk at 877-480-3201 or [email protected]] [Enter 10 digit number] 108 Management company [if filer is managed by another entity] 109 Complete mailing address of reporting entity corporate headquarters Street1 Street2 Street3 City State Zip (postal code) Country 110 Complete business address for customer inquiries and complaints check if same address as Line 109 Street1 Street2 Street3 City State Zip (postal code) Country 111 Telephone number for customer complaints and inquiries [Toll-free number if available] ( ) - ext - 112 List all trade names used in the past 3 years in providing telecommunications. Include all names by which you are known by customers. a g b h c i d j e k f l Use additional sheets if necessary. Each filer must provide all names used for telecommunications activities PERSONS MAKING WILLFUL FALSE STATEMENTS IN THE WORKSHEET CAN BE PUNISHED BY FINE OR IMPRISONMENT UNDER TITLE 18 OF THE UNITED STATES CODE, 18 U.S.C. § 1001 2027 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2026 Revenues) Page 2 Block 2-A: Regulatory Contact Information 201 Filer 499 ID [from Line 101] 202 Legal name of filer [from Line 102] 203 Person who completed this Worksheet First MI Last 204 Telephone number of this person ( ) - ext - 205 Fax number of this person ( ) - 206 Email of this person not for public release 207 Contact person name, office name, and mailing address of a corporate office to which correspondence regarding this Telecommunications Reporting Worksheet should be sent. check if same name as Line 203 check if same address as Line 109 Office Attn: First name MI Last Email not for public release Phone ( ) - ext- Fax ( ) - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - Street1 Street2 Street3 City State Zip (postal code) Country 208 Billing address and billing contact person [Plan administrators will send bills for contributions to this address. Please attach a written request for alternative billing arrangements.] check if name and address same as Line 207 Company Attn: First name MI Last Email not for public release Phone ( ) - ext- Fax ( ) - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - Street1 Street2 Street3 City State Zip (postal code) Country 208.1 Email address pertaining to ITSP regulatory fee issues not for public release Block 2-B: Agent for Service of Process All carriers and providers of interconnected and non-interconnected VoIP must complete Lines 209 through 213. During the year, these filers must refile Blocks 1, 2, and 6 if there are any changes in this section. See Instructions 209 D.C. Agent for Service of Process Company Attn: First name MI Last 210 Telephone number of D.C. agent ( ) - ext - 211 Fax number of D.C. agent ( ) - 212 Email of D.C. agent 213 Complete business address of D.C. agent for hand service of documents Street1 Street2 Street3 City State DC Zip 214 Local/alternate Agent for Service of Process (optional) Company Attn: First name MI Last 215 Telephone number of local/alternate agent ( ) - ext - 216 Fax number of local/alternate agent ( ) - 217 Email of local/alternate agent 218 Complete business address of local/alternate agent for hand service of documents Street1 Street2 City State Zip (postal code) Country PERSONS MAKING WILLFUL FALSE STATEMENTS IN THE WORKSHEET CAN BE PUNISHED BY FINE OR IMPRISONMENT UNDER TITLE 18 OF THE UNITED STATES CODE, 18 U.S.C. § 1001 2027 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2026 Revenues) Page 3 Block 2-C: FCC Registration and Contact Information Filers must refile Blocks 1, 2 and 6 if there are any changes in this section. See Instructions. 219 Filer 499 ID [from Line 101] 220 Legal name of filer [from Line 102] 221 Chief Executive Officer (or, highest ranking company officer if the filer does not have a chief executive officer) First MI Last 222 Business address of individual named on Line 221 check if same as Line 109 Street1 Street2 Street3 City State Zip (postal code) Country 223 Second ranking company officer, such as Chairman (Must be someone other than the individual listed on Line 221) First MI Last 224 Business address of individual named on Line 223 check if same as Line 109 Street1 Street2 Street3 City State Zip (postal code) Country 225 Third ranking company officer, such as President or Secretary (Must be someone other than individuals listed on Lines 221 and 223) First MI Last 226 Business address of individual named on Line 225 check if same as Line 109 Street1 Street2 Street3 City State Zip (postal code) Country 227 Indicate jurisdictions in which the filer provides service. Include jurisdictions in which service was provided in the past 15 months and jurisdictions in which service is likely to be provided in the next 12 months. Alabama Guam Massachusetts New York Tennessee Alaska Hawaii Michigan North Carolina Texas American Samoa Idaho Midway Atoll North Dakota Utah Arizona Illinois Minnesota Northern Mariana Islands U.S. Virgin Islands Arkansas Indiana Mississippi Ohio Vermont California Iowa Missouri Oklahoma Virginia Colorado Johnston Atoll Montana Oregon Wake Island Connecticut Kansas Nebraska Pennsylvania Washington Delaware Kentucky Nevada Puerto Rico West Virginia District of Columbia Louisiana New Hampshire Rhode Island Wisconsin Florida Maine New Jersey South Carolina Wyoming Georgia Maryland New Mexico South Dakota 228 Year and month filer first provided (or expects to provide) telecommunications in the U.S. Check if prior to 1/1/1999, otherwise: Year Month PERSONS MAKING WILLFUL FALSE STATEMENTS IN THE WORKSHEET CAN BE PUNISHED BY FINE OR IMPRISONMENT UNDER TITLE 18 OF THE UNITED STATES CODE, 18 U.S.C. § 1001 2027 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2026 Revenues) Page 4 Block 3: Carrier’s Carrier Revenue Information 301 Filer 499 ID [from Line 101] 302 Legal name of filer [from Line 102] Report billed revenues for January 1 through December 31, 2026. Do not report any negative numbers. Dollar amounts may be rounded to the nearest thousand dollars. However, report all amounts as whole dollars. See instructions regarding percent interstate and international. Total Revenues (a) If breakouts are not book amounts, enter whole percentage estimates Breakouts Interstate Revenues (d) International Revenues (e) Interstate (b) International (c) Revenues from Services Provided for Resale as Telecommunications by Other Contributors to Federal Universal Service Support Mechanisms Fixed local service 303.1 Monthly service, local calling, connection charges, vertical features, and other local exchange service including subscriber line and PICC charges to IXCs Provided as unbundled network elements (UNEs) 303.2 Provided under other arrangements 304.1 Per-minute charges for originating or terminating calls Provided under state or federal access tariff 304.2 Provided as unbundled network elements or other contract arrangement Local private line & business data service 305.1 Provided to other contributors for resale as telecommunications 305.2 Provided to other contributors for resale as interconnected VoIP 306 Payphone compensation from toll carriers 307 Other local telecommunications service revenues 308 Support revenues received from Federal or state sources Mobile services (i.e., wireless telephony, paging, and other mobile services) 309 Monthly, activation, and message charges except toll Toll services 310 Operator and toll calls with alternative billing arrangements (credit card, collect, international call-back, etc.) 311 Ordinary long distance (direct-dialed MTS, customer toll-free (800/888 etc.) service, “10-10” calls, associated monthly account maintenance, PICC pass-through, and other switched services not reported above) 312 Long distance private line services 313 Satellite services 314 All other long distance services 315 Total revenues from resale [Lines 303 through 314] See section III.C.2 of the instructions for the requirements applicable to revenue reported on this page. These records must be made available to the administrator or the FCC upon request. PERSONS MAKING WILLFUL FALSE STATEMENTS IN THE WORKSHEET CAN BE PUNISHED BY FINE OR IMPRISONMENT UNDER TITLE 18 OF THE UNITED STATES CODE, 18 U.S.C. § 1001 2027 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2026 Revenues) Page 5 Block 4-A: End-User and Non-Telecommunications Revenue Information 401 Filer 499 ID [from Line 101] 402 Legal name of filer [from Line 102] Report billed revenues for January 1 through December 31, 2026. Do not report any negative numbers. Dollar amounts may be rounded to the nearest thousand dollars. However, report all amounts as whole dollars. See instructions regarding percent interstate and international. Total Revenues (a) If breakouts are not book amounts, enter whole percentage estimates Breakouts Interstate Revenues (d) International Revenues (e) Interstate (b) International (c) Revenues from All Other Sources (end-user, telecom. & non-telecom.) 403 Surcharges or other amounts on bills identified as recovering State or Federal universal service contributions Fixed local services Monthly service, local calling, connection charges, vertical features, and other local exchange service charges except for federally tariffed subscriber line charges and PICC charges Traditional Circuit Switched 404.1 Provided at a flat rate including interstate toll service – local portion 404.2 Provided at a flat rate including interstate toll service – toll portion 404.3 Provided without interstate toll included (see instructions) Interconnected VoIP 404.4 Offered in conjunction with a broadband connection 404.5 Offered independent of a broadband connection 405 Tariffed subscriber line charges, Access Recovery Charges, and PICC charges levied by a local exchange carrier on a no-PIC customer 406 Local private line & business data service [Includes the transmission portion of wireline broadband Internet access provided on a common carrier basis.] 407 Payphone coin revenues (local and long distance) 408 Other local telecommunications service revenues Mobile services (i.e., wireless telephony, paging, and other mobile services) 409 Monthly and activation charges 410 Roaming and air-time charges for toll calls, but excluding separately stated toll charges PERSONS MAKING WILLFUL FALSE STATEMENTS IN THE WORKSHEET CAN BE PUNISHED BY FINE OR IMPRISONMENT UNDER TITLE 18 OF THE UNITED STATES CODE, 18 U.S.C. § 1001 2027 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2026 Revenues) Page 6 Block 4-A: Continued Total Revenues (a) If breakouts are not book amounts, enter whole percentage estimates Breakouts Interstate Revenues (d) International Revenues (e) Interstate (b) International (c) Toll services 411 Prepaid calling card (including card sales to customers and non-carrier distributors) reported at face value of cards 412 International calls that both originate and terminate in foreign points 0% 100% 413 Operator and toll calls with alternative billing arrangements (credit card, collect, international call-back, etc.) other than revenues reported on Line 412 Ordinary long distance (direct-dialed MTS, customer toll-free (800/888 etc.) service, “10-10” calls, associated monthly account maintenance, PICC pass-through, and other switched services not reported above) 414.1 All, other than interconnected VoIP, including, but not limited to, itemized toll on wireline and wireless bills 414.2 All interconnected VoIP long distance, including, but not limited to, itemized toll 415 Long distance private line services 416 Satellite services 417 All other long distance services Revenues other than U.S. telecommunications revenues, including information services, inside wiring maintenance, billing and collection, customer premises equipment, published directory, dark fiber, Internet access, cable TV program transmission, foreign carrier operations, and non-telecommunications revenues (See instructions) 418.1 bundled with circuit switched local exchange service 418.2 bundled with interconnected VoIP local exchange service 418.3 Other 418.4 non-interconnected VoIP revenues not included in any other category Block 4-B: Total Revenue and Uncollectible Revenue Information 419 Gross billed revenues from all sources (incl. reseller & non-telecom.) [Lines 303 through 314 plus Lines 403 through 418] 420 Gross universal service contribution base amounts [Lines 403 through 411 plus Lines 413 through 417] [See Table 3 in instructions.] 421 Uncollectible revenue/bad debt expense associated with gross billed revenues amounts shown on Line 419 [See instructions.] 422 Uncollectible revenue/bad debt expense associated with universal service contribution base amounts shown on Line 420 423 Net universal service contribution base revenues [Line 420 minus line 422] 2027 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2026 Revenues) Page 7 Block 5: Additional Revenue Breakouts 501 Filer 499 ID [from Line 101] 502 Legal name of filer [from Line 102] Filers that report revenues in Block 3 and Block 4 must provide the percentages requested in Lines 503 through 510. See instructions for limited exceptions. Percentage of revenues reported in Block 3 and Block 4 billed in each region of the country. Round or estimate to nearest whole percentage. Enter 0 if no service was provided in the region. Block 3 Carrier’s Carrier (a) Block 4 End-User Telecom (b) 503 Southeast: Alabama, Florida, Georgia, Kentucky Louisiana, Mississippi, North Carolina, Puerto Rico, South Carolina, Tennessee, and U.S. Virgin Islands % % 504 Western: Alaska, Arizona, Colorado, Idaho, Iowa, Minnesota, Montana, Nebraska, New Mexico, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming % % 505 West Coast: California, Hawaii, Nevada, American Samoa, Guam, Johnston Atoll, Midway Atoll, Northern Mariana Islands, and Wake Island % % 506 Mid-Atlantic: Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia, and, West Virginia % % 507 Mid-West: Illinois, Indiana, Michigan, Ohio, and Wisconsin % % 508 Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont % % 509 Southwest: Arkansas, Kansas, Missouri, Oklahoma, and Texas % % 510 Total: [Percentages must add to 0 or 100.] % % 511 Revenues from resellers that do not contribute to universal service support mechanisms are included in Block 4-B, Line 420 but may be excluded from a filer’s TRS, NANPA, LNP, and FCC interstate telephone service provider regulatory fee contribution bases. To have these amounts excluded the filer has the option of identifying such revenues below. As stated in the instructions, you must have in your records the FCC Filer 499 ID for each customer whose revenues are included on Line 511. (See instructions.) (a) (b) Total Revenues Interstate and International Revenues from resellers that do not contribute to Universal Service 512 Gross TRS contribution base amounts [Lines 403 through 417 plus Line 418.4 less Line 511] 513 Uncollectible revenue/bad debt expense associated with TRS contribution base amounts shown on Line 512 514 Net TRS contribution base revenues [Line 512 less Line 513] PERSONS MAKING WILLFUL FALSE STATEMENTS IN THE WORKSHEET CAN BE PUNISHED BY FINE OR IMPRISONMENT UNDER TITLE 18 OF THE UNITED STATES CODE, 18 U.S.C. § 1001 2027 FCC Form 499-A Telecommunications Reporting Worksheet (Reporting 2026 Revenues) Page 8 Block 6: CERTIFICATION: to be signed by an officer of the filer 601 Filer 499 ID [from Line 101] 602 Legal name of filer [from Line 102] Section IV of the instructions provides information on which types of filers are required to file for which purposes. Any filer claiming to be exempt from one or more contribution requirements should so certify below and attach an explanation. [The Universal Service Administrator will determine which filers meet the de minimis threshold based on information provided in Block 4, even if you fail to so certify below.] 603 I certify that the filer is exempt from contributing to: Universal Service TRS NANPA LNP Administration Provide explanation below: ________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________ 604 Please indicate whether the filer is State or Local Government Entity I.R.C. § 501 or State Tax Exempt (see instructions) 605 I certify that the revenue data contained herein are privileged and confidential and that public disclosure of such information would likely cause substantial harm to the competitive position of the company. I request nondisclosure of the revenue information contained herein pursuant to sections 0.459, 52.17, 54.711 and 64.604 of the Commission’s rules. I certify that I am an officer of the above-named filer as defined in the instructions, that I have examined the foregoing report and, to the best of my knowledge, information and belief, all statements of fact contained in this Worksheet are true and that said Worksheet is an accurate statement of the affairs of the above-named company for the previous calendar year. In addition, I swear, under penalty of perjury, that all requested identification registration information has been provided and is accurate. If the above-named filer is filing on a consolidated basis, I certify that this filing incorporates all of the revenues for the consolidated entities for the entire year and that the filer adhered to and continues to meet the conditions set forth in section III-B of the instructions. 606 Signature ______________________________________________________________________________ 607 Printed name of officer First MI Last 608 Position with reporting entity 609 Business telephone number of officer ( ) - ext - 610 Email of officer not for public release 611 Date 612 Check those that apply Original April 1 filing for year New filer, registration only Revised filing with updated registration Revised filing with updated revenue data Do not mail checks with this form. File this form online: https://forms.universalservice.org/portal/login For additional information regarding this worksheet contact: (888) 641-8722 or via email: [email protected] PERSONS MAKING WILLFUL FALSE STATEMENTS IN THE WORKSHEET CAN BE PUNISHED BY FINE OR IMPRISONMENT UNDER TITLE 18 OF THE UNITED STATES CODE, 18 U.S.C. § 1001