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Form 486 Step-by-StepReceipt of Service
Confirmation
Train-the-Trainer WorkshopSeptember 17-18, 2001
Schools & Libraries Division, USAC
Schools & Libraries Division, USACSeptember 17-18, 2001 2
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
Purpose Informs SLD when the Billed Entity and/or the
eligible entities it represents is receiving, is scheduled to receive, or has received service
Receipt by SLD triggers the process for SLD to receive invoices Universal service support will not be paid to a Service
Provider on an approved funding commitment prior to the SLD’s receipt of the Form 486
Schools & Libraries Division, USACSeptember 17-18, 2001 3
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
Purpose (cont.) Form 486 must be filed to accomplish the
following: To authorize the payment of invoices from your Service
Provider(s) To indicate approval of Technology Plans (as required) To indicate, starting in Funding Year 4, the status of
compliance with the Children’s Internet Protection Act (CIPA)
Schools & Libraries Division, USACSeptember 17-18, 2001 4
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
Impact of CIPA Requirements Beginning with Funding Year 4, the Children’s Internet
Protection Act (CIPA) requirements apply to Internet Access and Internal Connections requests Although CIPA requirements do not apply to Telecommunications
Services, Billed Entities applying only for Telecommunications Services must still, in general, make certifications to that effect
Certifications for the purpose of CIPA for Telecommunications Services, Internet Access and Internal Connections are featured on Form 486
Schools & Libraries Division, USACSeptember 17-18, 2001 5
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
Who must make the CIPA certification? The Administrative Authority for a school or library is the
entity that must make the relevant certification If the Administrative Authority is also the Billed Entity,
the Administrative Authority certifies on the Form 486 If the Administrative Authority is not the Billed Entity,
the Administrative Authority must complete Form 479 and submit Form 479 to the Billed Entity
Schools & Libraries Division, USACSeptember 17-18, 2001 6
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
Who Must File the Form 486? The Billed Entity representing a school,
school district, library (outlet/branch, system), or a consortium of those entities who completed and submitted the Form 471 to which the Form 486 relates
Schools & Libraries Division, USACSeptember 17-18, 2001 7
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
How Many Forms 486 to File? Early filing
You may have one or more early Forms 486 and one or more later Forms 486
Timing of start dates If multiple FRNs have the same or similar
start dates for service, you may file one Form 486 for all of those FRNs
Schools & Libraries Division, USACSeptember 17-18, 2001 8
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
How Many Forms 486 to File? (cont.) Availability of information
All components of information are required to be completed
If required information for a particular FRN is missing, a separate Form 486 should be submitted for that FRN
Your Form 486 may be rejected and returned to you without being accepted and processed if information is missing
Schools & Libraries Division, USACSeptember 17-18, 2001 9
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
How Many Forms 486 to File? (cont.) You must complete a separate Form 486 if:
You receive Funding Commitment Decision Letters (FCDLs) featuring more that one entity number
The Item 11a certification applies to certain FRNs and the Item 11b certification applies to other FRNs (for Funding Year 4 and later)
You file a waiver of CIPA requirements for a portion of your funded FRNs (for Funding Year 5 and later)
Schools & Libraries Division, USACSeptember 17-18, 2001 10
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
When to File? No earlier than the receipt of an FCDL Funding Years 1, 2, and 3
Should file within ten days of the start of services
Funding Year 4 and later See CIPA presentation for detailed information on
deadlines for Funding Year 4 and later
Schools & Libraries Division, USACSeptember 17-18, 2001 11
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
Where to File? File with Schools and Libraries Division
Manually, mailing address (P.O. Box):SLD - Form 486
P.O. Box 7026Lawrence, KS 66044-7026
Schools & Libraries Division, USACSeptember 17-18, 2001 12
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
Where to File? (cont.) File with Schools and Libraries Division
Manually (Express delivery or U.S. Postal Service Return Receipt)
SLD - Form 486c/o Ms. Smith3833 Greenway DriveLawrence, KS 66046Telephone number for receipt purposes: 888-203-8100
Schools & Libraries Division, USACSeptember 17-18, 2001 13
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Receipt of Service Confirmation Form
Compliance Schools and libraries filing false information are
subject to penalties Applicants should retain the records they use to
complete these forms for five years If applicants represent multiple entities, the data
collected from those entities must also be kept for five years
Schools & Libraries Division, USACSeptember 17-18, 2001 14
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486: Top of Form, page 1
Data are used to help both applicant and SLD identify each Form 486 you file Do Not Write In This Area: Space is used to apply a
barcode upon receipt to track and archive your form Applicant’s Form Identifier: Use this space to assign a
number or letter of your own devising to facilitate communication with SLD about THIS particular Form 486.
Form 486 Application #: The SLD will insert your Form 486 number. Leave this item blank.
Schools & Libraries Division, USACSeptember 17-18, 2001 15
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486: Top of Form, pages 2-5
Top of each page after page 1: To help alleviate problems caused if pages of the application become separated, please provide: Entity Number (from Item 2 below) Applicant’s Form Identifier (from Top of Form, page 1) Name of Contact Person (from Item 5 below) Contact Person Telephone Number (from Item 5 below)
Schools & Libraries Division, USACSeptember 17-18, 2001 16
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 1:Billed Entity Information
Item 1 – Name of Billed Entity Provide the name of the Billed Entity as
indicated on the corresponding Funding Commitment Decision Letter (FCDL)
Item 2 – Billed Entity Number Provide the Billed Entity Number as it
appears on your FCDL
Schools & Libraries Division, USACSeptember 17-18, 2001 17
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 1:Billed Entity Information
Item 3 – Funding Year Provide the Funding Year for which your
funds were approved, e.g., “07/01/2001–06/30/2002”
The Funding Year must be the same as the Funding Year contained in your FCDL for the corresponding Form 471
Cite only one Funding Year in this item
Schools & Libraries Division, USACSeptember 17-18, 2001 18
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 1:Billed Entity Information
Item 4 – Complete Mailing Address of Billed Entity Street Address, P.O. Box or Route Number, City, State, Zip
Code You are strongly encouraged to provide a street address
rather than a P.O. Box if possible 10-Digit Telephone Number (plus extension) Fax Telephone Number (10 digits) E-Mail Address (50 characters maximum)
Schools & Libraries Division, USACSeptember 17-18, 2001 19
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 1:Billed Entity Information
Item 5 – Contact Person Information Contact Person Name
Provide the name of the person who should be contacted with questions about this form
Contact Person Mailing Address (if different from Item 4) Provide the mailing address for the Contact Person, and
10-digit telephone number, fax number, and e-mail address if different from the information in Item 4
Check the preferred mode of contact
Schools & Libraries Division, USACSeptember 17-18, 2001 20
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 2a:FUNDING YEAR 4 ONLY –Early Filing Information
Item 6A – Early Filing for Funding Year 4 Check this box if you wish to file your Form 486 before
services have started in Funding Year 4. You may file early if: You have received your FCDL You have confirmed with the named Service Provider
that services you ordered will start on the Service Start Date, which must be on or before October 28, 2001
You are able to accurately make all relevant certifications in Block 4, and
Schools & Libraries Division, USACSeptember 17-18, 2001 21
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 2a:FUNDING YEAR 4 ONLY –Early Filing Information
Item 6A – Early Filing for Funding Year 4 (cont.) Your Form 486, including your certification in
Item 11, must be postmarked on or before October 28, 2001
If you are submitting Form 486 after services have started, do not check this box
Schools & Libraries Division, USACSeptember 17-18, 2001 22
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 2b:FUNDING YEARS AFTER FUNDING YEAR 4 –
Early Filing Information & CIPA Waiver Request
Item 6B – Early Filing after Funding Year 4 Check this box if you wish to file your Form 486 before
services have started in Funding Years after Funding Year 4. You may file early if: You have received your FCDL You have confirmed with the named Service Provider that the
services you ordered will start on the Service Start Date, which must be on or before July 31 of the relevant Funding Year
You are able to accurately make all relevant certifications in Block 4
Schools & Libraries Division, USACSeptember 17-18, 2001 23
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 2b:FUNDING YEARS AFTER FUNDING YEAR 4 –
Early Filing Information & CIPA Waiver Request
Item 6B – Early Filing after Funding Year 4 (cont.) Your Form 486, including your certification in
Item 11, must be postmarked on or before July 31 of the relevant Funding Year
If you are submitting Form 486 after services have started, do not check this box
Schools & Libraries Division, USACSeptember 17-18, 2001 24
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 2b:FUNDING YEARS AFTER FUNDING YEAR 4 –
Early Filing Information & CIPA Waiver Request
Item 6C – CIPA Waiver Request If you are a Billed Entity who is also the
Administrative Authority for the purpose of CIPA, you must check this item if you need to request a waiver from CIPA requirements in the Second Funding Year in which you “apply” for funds (See CIPA presentation for further details)
Schools & Libraries Division, USACSeptember 17-18, 2001 25
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 3:Service Information
Item 7 – Service Information Provide the information for each Form 471 Block 5
(Discount Funding Request). This information must be obtained from the FCDL sent to you by SLD. Column (A) – 471 Application Number Column (B) – FRN for the services to be provided Column (C) – Billing Account Number (if contained in your
FCDL) Column (D) – Service Provider Name Column (E) – Service Provider Identification Number (SPIN)
Schools & Libraries Division, USACSeptember 17-18, 2001 26
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 3:Service Information
Item 7 – Column F, Funding Year Service Start Date For each FRN, provide the date on which the
service for that FRN started or, in certain circumstances, is scheduled to start
In no instance can this date be earlier than July 1 of the relevant Funding Year
The FRNs listed must be from the same Funding Year as is listed in Block 1, Item 3
Schools & Libraries Division, USACSeptember 17-18, 2001 27
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Item 8 – Technology Plan Certifications Certify that the technology plan(s) covering the services listed for
all the eligible entities who are recipients of services covered under your Form 486 have been approved by an authorized organization(s) certified by the SLD
Provide the name(s) of the organization(s) who are the technology plan approver(s) that approved a technology plan for any eligible entity receiving services covered under your Form 486
If EVERY FRN listed in the Form 486 is for basic telephone service only, enter “none.”
Schools & Libraries Division, USACSeptember 17-18, 2001 28
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Item 9 – Services Certifications Certify that the services listed on this Form 486 are planned to
be or are being provided to the eligible entities identified in the Form 471 application(s) cited in this Form 486
Certify that there are signed contracts covering all the services listed except for those services provided under tariff or on a month-to-month basis
Certify that the individual signing on behalf of the Billed Entity is authorized to submit the information and that all statements of fact contained in Form 486 are true
Schools & Libraries Division, USACSeptember 17-18, 2001 29
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Item 10 – Shared Service and Audit Certifications Certify that you understand that the discount level used for
shared services is conditional, for future years, upon ensuring that the most disadvantaged schools and libraries treated as sharing in the services receive an appropriate share of benefits from those services
Certify that you recognize that you may be audited pursuant to this application; that you will retain for five years any and all records that you rely upon to complete this form and, if audited, that you will make available to the SLD such records
Schools & Libraries Division, USACSeptember 17-18, 2001 30
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Item 11 – CIPA Certifications This item concerns compliance with the
requirements of the Children’s Internet Protection Act (CIPA)
If this Form 486 pertains to a Funding Year prior to Funding Year 4, skip Item 11 and go to Item 12
If this Form 486 pertains to Funding Year 4 or later, Item 11 must be completed
Schools & Libraries Division, USACSeptember 17-18, 2001 31
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Item 11 – CIPA Certifications (cont.) General Instructions
A Billed Entity who is a recipient of service must check Item 11a or 11b or 11c
A Billed Entity who represents one or more Administrative Entities must check Item 11d or 11e
For Funding Years after Funding Year 4, a Billed Entity who must collect Forms 479 and who checks Item 11d must check Item 11f or 11g
Schools & Libraries Division, USACSeptember 17-18, 2001 32
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Item 11 – CIPA Certifications (cont.) For a Billed Entity who is the Administrative Authority
Check Item 11a if you certify that the recipients of service have complied with CIPA requirements
Check Item 11b if you certify that the recipients of service are undertaking actions to comply with CIPA for the next Funding Year, but have not completed all requirements of CIPA for this Funding Year
Schools & Libraries Division, USACSeptember 17-18, 2001 33
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Item 11 – CIPA Certifications (cont.) For a Billed Entity who is the Administrative Authority
Check Item 11c if you certify that CIPA does not apply because the recipients of service are receiving discount services only for Telecommunications Services
Remember to check only the ONE box in Items 11a through 11c that describes the status of compliance with CIPA
Schools & Libraries Division, USACSeptember 17-18, 2001 34
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Item 11 – CIPA Certifications (cont.) For a Billed Entity who represents one or more
Administrative Authorities Check Item 11d if you certify, as the Billed Entity for the
consortium or for the Administrative Authorities you represent, that you have collected duly completed and signed Forms 479
Check Item 11e if you certify, as the Billed Entity for the consortium or for the Administrative Authorities you represent, that the only services for which you have been approved for discounts are Telecommunications Services, and therefore the requirements of CIPA do not apply
Schools & Libraries Division, USACSeptember 17-18, 2001 35
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Item 11 – CIPA Certifications (cont.) For a Billed Entity who represents one or more
Administrative Authorities For Funding Years after Funding Year 4: Check Item 11f if you
certify, as the Billed Entity for the Administrative Authorities you represent, that some or all of the entities who filed Form 479 are seeking a CIPA Waiver by checking Form 479 Item 6d
For Funding Years after Funding Year 4: Check Item 11g if you certify, as the Billed Entity for the Administrative Authorities you represent, that none of the entities who filed Form 479 is seeking a CIPA Waiver by checking Form 479 Item 6d
Schools & Libraries Division, USACSeptember 17-18, 2001 36
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486, Block 4:Certifications and Signature
Items 12-16 – Authorized Signature The Authorized Person must sign the form using
an original ink signature in Item 12 and provide: Item 13 - Signature Date Item 14 - Printed Name of Authorized Person
whose signature is provided in Item 12 Item 15 - Title or Position of Authorized Person Item 16 - Telephone Number of Authorized Person
Schools & Libraries Division, USACSeptember 17-18, 2001 37
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Form 486 – Filing of Form
Submit completed form: Mailing Address:
SLD - Form 486P.O. Box 7026Lawrence, KS 66044-7026
For express delivery services or U.S. Postal Service Return Receipt Requested: SLD - Form 486
c/o Ms. Smith3833 Greenway DriveLawrence, KS 66046Telephone number for receipt purposes: 888-203-8100
Schools & Libraries Division, USACSeptember 17-18, 2001 38
The information on this slide is believed to betrue and accurate as of September 4, 2001.
Where to Go For Help
On the Web: www.sl.universalservice.org Client Service Bureau: 1-888-203-8100 Via E-mail: [email protected] Via fax: 1-888-276-8736