FY=97 · Web view(Reference: OAC 165:59-3-66) Preapproval is an optional process available to OUSF Beneficiaries who desire to have certainty regarding the amount that will be funded

OKLAHOMA UNIVERSAL SERVICE FUND REQUEST FOR FUNDING AND

REQUEST FOR PREAPPROVALINSTRUCTION PACKAGE

Updated: May 16, 2018

Oklahoma Corporation Commission Public Utility Division

Jim Thorpe Building, Suite 580 Oklahoma City, OK 73105 (405) 521-4114

TABLE OF CONTENTS

PAGE SECTION ONE

Locating Forms for Requesting Funding from the OUSF and OLF.........................4

Locating OUSF Information on the Web ................................................................ 4

Procedure for Requesting Preapproval for OUSF Funding...................................4

Procedures for Requesting Funding f rom the OUSF .............................................. 5

Deficiencies in the Request for OUSF Funding ...................................................... 7

Requests from the OUSF Administrator for Additional Information........................7

If You Have Questions ........................................................................................... 7

Documents Required to File a Request for OUSF Funding………………………….7

Procedure for Filing Request for OUSF Funding ................................................... 9

SECTION TWO Required Funding Request Forms and Instructions.............................................10

Supporting Work Papers and Documentation ...................................................... 10

Required Application Form Instructions ................................................................ 10

SECTION THREE Oklahoma Lifeline Fund (OLF) Service Program..................................................11

Recertification......................................................................................................13

Procedures for Requesting Reimbursement from the OLF...................................13

Recovery of Contribution......................................................................................14

SECTION FOUR PRIMARY UNIVERSAL SERVICES / REQUEST FOR OUSF FUNDING TEMPLATE …………………………………………………………………………….15

SPECIAL UNIVERSAL SERVICES / REQUEST FOR OUSF FUNDING TEMPLATE ...............…………………………………………………………………18

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TABLE OF CONTENTS (continued)

PAGE

SECTION FIVE Primary Universal Service Request Form (Form PUSF–1)...................................22

Special Universal Service Request Form (Form SUSF-2) / Internet Access Schools and Libraries..…………………………….……………………….…...25

Special Universal Service Request Form (Form SUSF-3) / Telemedicine for Healthcare Providers………………………………………………………….…27

Oklahoma Universal Service Fund Lifeline Reimbursement Request Form (Form OLF–1)...............................................................................................29

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SECTION ONE

FILING GUIDANCE

LOCATING FORMS FOR REQUESTING FUNDING FROM THE OKLAHOMA UNIVERSAL SERVICE FUND (“OUSF”) AND THE OKLAHOMA LIFELINE FUND (“OLF”)

The appropriate forms necessary for making an OUSF or OLF funding request shall be available on the Commission’s website at the following location http://www.occeweb.com/pu/OUSF/OUSF.htm and may be obtained from the OUSF Administrator (the “Administrator” or Public Utility Division “PUD”).(Reference: OAC 165:59-3-61)

LOCATING OUSF INFORMATION ON THE WEB

(1) Go to the OCC server home page (www.occeweb.com) (2) Select “Divisions”(3) Select “Public Utility”(4) Click on “Telephone”(5) Click on “Oklahoma Universal Service Fund”(6) Then choose from the menu the particular information you seek

PROCEDURES FOR REQUESTING PREAPPROVAL FOR OUSF FUNDING(Reference: OAC 165:59-3-66)

Preapproval is an optional process available to OUSF Beneficiaries who desire to have certainty regarding the amount that will be funded from the OUSF in support of Special Universal Services on behalf of the OUSF Beneficiary.

(1) The OUSF Beneficiary may submit a "Request for OUSF Preapproval" to the OUSF Administrator to determine eligible services and credit amounts for the upcoming funding year.

(2) A Request for OUSF Preapproval may be submitted at any time by sending via electronic mail a digital copy of all required documentation to the OUSF Administrator, to the email address [email protected]

(3) The Request for OUSF Preapproval shall include the following:

(a) All documents and information required by the approved form; and

(b) All documents identified in 17 O.S. § 139.109.1(F)(2)(d).

(4) The Request for OUSF Preapproval may include any documentation that would assist the OUSF Administrator in independently evaluating the request.

(5) The OUSF Administrator shall independently evaluate and review the Request for OUSF Preapproval, including all provided documentation, and issue an OUSF preapproval funding letter, without Commission order, to

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mailto:[email protected]

http://www.occeweb.com/pu/OUSF/OUSF.htm

the OUSF Beneficiary within ninety (90) calendar days of receipt of the Request for OUSF Preapproval. The preapproval funding letter shall be electronically delivered to the OUSF Beneficiary.

(6) A Request for OUSF Preapproval that is found by the OUSF Administrator to be incomplete, i.e., missing affidavits, bid information or other pertinent information may be denied.

(7) After a preapproval funding letter has been issued, an OUSF Beneficiary may submit a new Request for OUSF Preapproval to provide corrections or provide additional information; however, a new Request shall be submitted for each funding year. This new Request shall be submitted by sending via electronic mail a digital copy of all required documentation to the OUSF Administrator, to the email address [email protected].

(8) Unless an OUSF Beneficiary receives preapproval of a Request for OUSF Preapproval, the Beneficiary shall not identify the OUSF as the source of secured funds for any purpose.

(9) The amount of OUSF funding preapproved under this subsection shall be subject to adjustments based on the amount of support received from other sources, if any, as well as adjustments to pricing that may occur between the time of preapproval and installation of service.

(10) Additional services that are installed beyond those contained in the Request for OUSF Preapproval shall require either a new Request for OUSF Preapproval or a Request for OUSF Funding to be filed.

(11) Variance from the terms approved in the OUSF preapproval funding letter, which could have impacted bid selection may make the previously issued OUSF preapproval funding letter null and void.

(12) A Request for OUSF Preapproval submitted by an OUSF Beneficiary shall be signed by an authorized agent of the OUSF Beneficiary, or by the attorney for the OUSF Beneficiary.

PROCEDURES FOR REQUESTING FUNDING FROM THE OUSF(Reference: OAC 165:59-3-68 or 165:59-3-70)

Note: All eligible telecommunication service providers are encouraged to obtain and review a complete set of the OCC Rules (Chapter 59) related to OUSF. http://www.occeweb.com/rules/rulestxt.htm

(1) An eligible telecommunications carrier or eligible provider of Special Universal Services requesting funds from the OUSF shall file a “Request for OUSF Funding” with the Commission Court Clerk’s Office. Documentation not filed with the Court Clerk’s Office, in support of the “Request for OUSF Funding”, should be given directly to the OUSF Administrator or e-mailed to [email protected]

(2) Requests for OUSF Funding found to be missing required information, i.e., affidavits, bid information, invoices, contracts or tariffs appropriate SUSF

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http://www.occeweb.com/rules/rulestxt.htm


forms, etc., may result in a denial of the requested funding.

(3) It is the intention of the Commission that each funding request will be reviewed on a case-by-case basis. For requests regarding Primary Universal Services, the eligible local exchange telecommunications service provider shall make every reasonable and timely effort to obtain funding from alternative funding sources designated to support Universal Service or an explanation for why alternative funding is not available.

For requests regarding Special Universal Services the OUSF Beneficiary shall make every reasonable and timely effort to obtain funding from state and/or federal funds, such as the federal School and Libraries Program or the Rural Health Care Programs designed to support Special Universal Services. The OUSF will fund either the lowest cost reasonable qualifying bid, or a bid that is no more than 25% above the lowest cost reasonable qualifying bid, inclusive of all non-recurring eligible charges, for the eligible bandwidth range of the OUSF Beneficiary. If the selected bid is more than 25% above the lowest cost reasonable qualifying bid, the OUSF will fund the lowest cost reasonable qualifying bid plus the 25%.

(4) If an eligible local exchange telecommunications service provider or eligible service provider receives funding from alternative funding sources for an investment, expense or service reimbursed by the OUSF, the company shall reduce the amount of any prospective funding request from the OUSF by an equivalent amount. Under no circumstances will double recovery be allowed.

(5) Concurrent with the filing of the Request for OUSF Funding, the eligible telecommunications carrier or eligible service provider requesting funding from the OUSF shall provide copies of the Notice of the Request for OUSF Funding to the OUSF Administrator, to the Oklahoma Attorney General to the OUSF Beneficiary and to each telecommunications carrier in the State of Oklahoma, which is a contributor to the OUSF. In addition, the eligible telecommunications carrier or eligible service provider requesting funding shall provide copies of the Request for OUSF Funding to the Attorney General, to the OUSF Beneficiary and, upon request, to other telecommunications carriers. The Administrator shall provide a list of the contributors to the OUSF upon request by an eligible telecommunications carrier or eligible service provider.

(6) The Request for OUSF Funding shall be reviewed and processed consistent with OAC 165:59-3-68 for Special Universal Service requests or 165:59-3-70 for Primary Universal Service requests.

(7) Any adversely affected party shall have fifteen (15) days to file a request for reconsideration by the Commission of the Determination made by the Administrator. The party requesting reconsideration shall give notice of the

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request for reconsideration to the provider making the Request for OUSF Funding, the Attorney General, the OUSF Administrator, and all parties to the Cause. Upon filing the Request for Reconsideration and the Notice of Prehearing Conference, the Request for Reconsideration shall, without Commission order, be assigned to an ALJ, and set for hearing on the next regularly scheduled prehearing conference date, which is at least five (5) business days after the date of filing, unless the parties agree or the Commission directs otherwise.

(8) Unless good cause is shown, any request for OUSF funding should be made within eighteen (18) months from the date the requesting eligible service provider can determine the impact of occurrence of the circumstance giving rise to the request; however, if an OUSF Beneficiary has obtained a preapproval funding letter from the OUSF Administrator, the eligible provider shall make a request for funding within 60 days of the start of service. (Reference: OAC 165:59-3-68-m).

DEFICIENCIES IN THE REQUEST FOR OUSF FUNDING

Any Request for OUSF Funding may be denied if the Request is found to be incomplete. (Reference: OAC 165:59-3-68-e and 165:59-3-70-e).

REQUESTS FROM THE OUSF ADMINISTRATOR FOR ADDITIONAL INFORMATION

The OUSF Administrator may request additional information from the eligible service provider, eligible telecommunications carrier, or the beneficiary as is necessary to fully evaluate the Request for OUSF Funding. This information must be provided in a timely manner (generally ten (10) business days) from the date that such information is requested by the OUSF Administrator.

IF YOU HAVE QUESTIONS

When you have questions regarding how to request funding from the OUSF, please contact:

Oklahoma Universal Service Fund Administrator Oklahoma Corporation CommissionPublic Utility Division P.O. Box 52000Oklahoma City, OK 73152-2000 (405) [email protected]

DOCUMENTS REQUIRED TO FILE A REQUEST FOR OUSF FUNDING(File the following items are to be filed with the OCC Court Clerk)

(1) Request for OUSF Funding with corresponding Certificate of Mailing

(2) Notice of Request for OUSF Funding

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(3) SUSF Form (the Excel version of the SUSF Form must be sent to PUD via email on the same day the Request is filed, and the email must include the Excel version of the SUSF Spreadsheet)

(4) * Affidavit and Attachments to the Affidavit – see below for examples

REMINDER: Pursuant to OAC 165:59-7-17, prior to signing a contract with a school, library or recipient of a telemedicine line, the provider shall provide to the OUSF Beneficiary written information regarding the limitations on funding from the OUSF.

*Affidavit and Attachments to the Affidavit - examples:

A. When there has not been a Preapproval, provide:

Affidavit and all required Attachments

B. When an Approval Funding Letter (“AFL”) has been issued:

1. When a AFL was issued prior to the Beneficiary’s selection of a bid, and then the Beneficiary selected the Lowest Cost Reasonable Qualifying Bid (“LCRQB”) and no other changes have occurred – provide:

Updated Affidavit if there has been any changes

Any Attachments to the Affidavit not previously provided or that have changed, e.g., FCC Form 471, contract, invoices

2. When a AFL was issued after the bandwidth/bid/carrier was selected by the Beneficiary, the Beneficiary selected the LCRQB, and no changes have occurred (including changes to the Affidavit) – provide:

Any Attachments to the Affidavit not previously provided, e.g., disconnect information, invoices

3. When a AFL was issued after the bandwidth/bid/carrier was selected by the Beneficiary but prior to when the Beneficiary filed its FCC Form 471, and then the Beneficiary selected a different bandwidth/carrier/bid – If the Beneficiary seeks and receives Preapproval and then submits a Request for Funding that does not reflect/match the AFL, the Request is considered to be a “new/different” Request which has not been Preapproved. Provide:

Updated Affidavit if there has been any changes


4. When a AFL was issued after the bandwidth/bid/carrier was selected by the Beneficiary but prior to when the Beneficiary filed its FCC Form 471, and

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then the Beneficiary selected a different bandwidth/carrier/bid in order to select the LCRQB – provide:

Updated Affidavit


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PROCEDURE FOR FILING REQUEST FOR OUSF FUNDING (Reference: OAC 165:59-3-68 and 165:59-3-70).

(1) File with the Oklahoma Corporation Commission Court Clerk:

(a) The completed Request for OUSF Funding, along with four (4) copies, must be filed with the Oklahoma Corporation Commission Court Clerk. The supporting documentation must be submitted to the OUSF Administrator.

(b) There is no filing fee for requests filed on the Oklahoma Universal Service Fund Docket (“OSF Docket”).

(c) The Commission Court Clerk’s business hours are from 8:00 a.m. to 4:30 p.m., Monday through Friday, except on State holidays. The Commission’s Cashier, however, closes at 4:00 p.m. each day, thereby precluding the filing of a new application after 4:00 p.m., because new cause numbers are assigned by the Cashier.

(d) The Commission Court Clerk’s office is located on the first floor of the Jim Thorpe Building, room 130. The street address of the Jim Thorpe Building is 2101 North Lincoln, Oklahoma City, Oklahoma 73105.

(2) A copy of the Request for OUSF Funding and one set of supporting documentation is required to be delivered to the State Attorney General (“AG”):

Dara DerryberryOffice of the Oklahoma Attorney General 313 NE 21st StreetOklahoma City, OK 73105

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SECTION TWO

REQUIRED FUNDING REQUEST FORMS AND INSTRUCTIONS

(1) Section Four contains a copy of the required Request for OUSF Funding Form that must be submitted with your complete documentation when requesting funding from the OUSF. In addition, this section contains an instruction sheet for each Form included in this section.

(2) Each Request for OUSF Funding for a school, library, or healthcare entity (telemedicine) or a Request for Change in Funding must contain a completed Affidavit in Support of Request for Special Universal Services (“Affidavit”). Use the Affidavit designed for the specific type of entity (school, library, or healthcare facility) found at: http://www.occeweb.com/pu/OUSF/OUSF.htm.

(3) Each eligible service provider or eligible telecommunications carrier should review each Form and read carefully the instruction sheets for each Form to assure that the required Forms are complete and accompanied by the required supporting documentation. Please keep in mind that any Request for OUSF Funding m a y b e denied if the appropriate Forms are not used or said Forms are not determined to be complete.

SUPPORTING WORK PAPERS AND DOCUMENTATION

Applicants are required to provide a sufficient and competent level of supporting work papers and documentation in order to fully explain the basis of the request and to show that the level of funding requested is accurate and properly calculated. Support documents should be in “Word” and/or “Excel” formats, i.e., DOCX version of affidavits and Excel version of SUSF forms and attachments. Please note that certain supporting documentation is to be provided directly to the PUD and the AG on the day the application is filed. Any filing that fails to be accompanied by a sufficient and competent level of supporting documentation will be deemed to be incomplete and may result in a denial of some or all of the requested funding. A detailed discussion of the required support documentation is contained in the instructions contained in each Form.

REQUIRED APPLICATION FORM INSTRUCTIONS

The required Application Form is the lead document in your application package and provides general information regarding the funding support request as well as serving as the document that will be stamped with the

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Cause Number related to the filing.

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SECTION THREE

OKLAHOMA LIFELINE FUND (OLF) SERVICE PROGRAM(Reference: OAC 165:59-9-3)

(1) The Oklahoma Lifeline Fund (OLF) is a program designed to operate in conjunction with the Federal Lifeline program, to provide a monthly credit to the month ly b i l l o f qua l i f y ing res ident ia l subscr ibers fo r bas ic loca l exchange se rv ice , in an amount equa l to such amount as may be es tab l ished by 17 O.S . § 139.105 .

(2) In order to qualify for the Oklahoma Lifeline Service Program, a customer must meet a l l a p p l i c a b l e requirements of 47 CFR §§ 54.400 through 54.422 and/or 17 O.S. § 139.105.

(3) Each eligible local exchange telecommunications service p r o v i d e r shall file tariffs implementing a Lifeline Service Program that is consistent with this Subchapter.

(4) Lifeline Assistance shall not be available on a retroactive basis to the customers.

(5) Upon notification to the eligible loca l exchange telecommunications serv ice prov ider , the credit will be discontinued for customers who no longer qualify for Lifeline Assistance.

(6) Lifeline Service benefits are applicable only to the primary line at the customer’s principal residence. An applicant for Lifeline Service may report only one address in the state as the principal place of residence.

(7) As a participant in Lifeline Assistance, customers will be eligible to receive Toll Restriction Service at no charge.

(8) Each e l i g i b l e l oca l exchange telecommunications service provider with approved Lifeline Service tariffs shall advertise the availability of the Lifeline Service Program within its exchange(s) or service territory on, at a minimum, an annual basis.

(9) The wireless eligible local exchange telecommunications service provider must provide access to its own customer service department by dialing 611 from the wireless handset or have a toll free number for contacting the eligible local exchange telecommunications service provider programmed in the phone and clearly identified.

(10) All enrollments in any Lifeline Services from any outdoor mobile location or by door to door sales shall be governed by OAC 165:55-23-16.

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(11) Any wireless handset provided in conjunction with the Lifeline Service must clearly and permanently identify the provider of the service.

(12) An eligible local exchange telecommunications service provider may not provide Lifeline Service purely by resale without a Commission order.

(13) An approved Lifeline tariff may not be modified without submitting the modification to the OLF Administrator at least fifteen (15) days prior to the effective date of the proposed change for the purpose of receiving a determination whether the modification is in the public interest. Unless the eligible local exchange telecommunications service provider receives written notification that its modification is NOT IN THE PUBLIC INTEREST within fifteen (15) calendar days after its submission, the submission is deemed to be in the public interest and may be implemented.

(14) The eligible local exchange telecommunications service provider shall utilize a third party verification system that has been approved by the OLF Administrator to verify the customer's identity and address, or obtain a waiver from the OLF Administrator from this requirement.

(15) The eligible local exchange telecommunications service provider must retain a copy of the signed application for Lifeline Service, and any recertification information for five (5) years.

(16) The eligible local exchange telecommunications service provider shall maintain a database sufficient to identify any duplicates among all companies associated with the eligible local exchange telecommunications service provider.

(17) Unless otherwise approved by Commission Order, any Lifeline plan offered by a wireless provider must comply with the minimum service standards for voice services detailed at 47 C.F.R. § 54.408.

(18) All marketing efforts must clearly identify the eligible local exchange telecommunications service provider actually providing the Lifeline Service.

(19) In addition to other remedies available to the Commission, violations of the marketing rules may result in a minimum of a thirty (30) days suspension of an eligible local exchange telecommunications service provider’s ability to sign up new customers and/or a fine as authorized by 17 O.S. § 139.105 after notice and hearing.

(20) The eligible local exchange telecommunications service provider seeking reimbursement from the OLF for the provisioning of Lifeline services shall also note on the certified written statement obtained from the customer the name of the employee or representative who verified the customer's eligibility for Lifeline service and the type of documentation reviewed.

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(21) Prior to obtaining money from the OLF, an eligible local exchange telecommunications service provider must show compliance with 17 O.S. § 139.105(E).

RECERTIFICATION (Reference: OAC 165:59-9-5)

Each eligible local exchange telecommunications service provider, eligible to receive Lifeline support from the OLF and/or the federal Lifeline Fund shall, annually, require each end-user subscriber to recertify confirming their continued eligibility for the State or Federal Lifeline program. The eligible local exchange telecommunications service provider shall retain a copy of the signed recertification form for three (3) years.

PROCEDURES FOR REQUESTING REIMBURSEMENT FROM THE OLF (Reference: OAC 165:59-9-25)

(1) Any eligible local exchange telecommunications service provider with approved Lifeline Service tariffs may apply to the Administrator or contracted agent of the OLF for reimbursement of the Lifeline Service Program credits provided for residential basic local service.

(2) Upon receipt of a “Request for OLF Funding,” the Administrator or contracted agent shall i n d e p e n d e n t l y e v a l u a t e a n d review the Request and supporting documentation and, as appropriate, pay the applicable amount to the eligible local exchange telecommunications service provider, as provided in the Oklahoma Telecommunications Act.

(3) A telecommunications carrier seeking reimbursement of eligible Lifeline Services Program credits from the OLF shall:

(a) File a “Request for OLF Funding” with the Commission’s Court Clerk. There is no filing fee for requests filed on the OSF Docket.

(b) Concurrent with filing the Request for OLF Funding, the eligible local telecommunications service provider who is requesting funding from the OLF shall provide notice, which shall include the dollar amount of the request for lump sum and any recurring amounts, of the Request for OLF Funding to the OLF Administrator, the Oklahoma Attorney General, and to each contributing provider by providing an electronic copy of such notification to the OLF Administrator on the date the eligible local exchange telecommunications service provider files its Request for OLF Funding with the Court Clerk, for posting on the Commission website. The OLF Administrator will then place the notification on the Commission website within five (5) business days.

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(4) An eligible local exchange telecommunications service provider may not receive reimbursement from the OLF unless it demonstrates that its rates have been reduced by an amount equal to the amount of the Lifeline payments that were previously included in the rate structure of the eligible local exchange telecommunications service provider. An eligible local exchange telecommunications service provider shall be eligible for support from the OLF for any amount which is greater than the amount which has been previously included in the rate structure of the eligible local exchange telecommunications service provider.

(5) The OLF Administrator shall independently review and determine the accuracy of the complete request and issue a Determination of the eligibility for funds, which details the amount of funding recoverable from the OLF, within 90 days. Simultaneously with the OLF Administrator advising the eligible local exchange telecommunications service provider and parties to the cause, the OLF Administrator shall file the written Determination with the Commission’s Court Clerk and post it to the Commission’s website.

(6) Any affected party may file a request for reconsideration within 15 days of the Determination being filed by the Administrator, by following the procedures in OAC 165:59-3-72.

(7) Any Request for Reconsideration will be process using the provisions set forth in OAC 165:59-3-72.

(8) The O L F Administrator o r c o n t r a c t e d a g e n t shall ensure that all OLF funds have been received and are on deposit in a sufficient manner so as to pay requests for OLF Funding in accordance with the Oklahoma Telecommunications. The OLF Administrator o r c o n t r a c t e d a g e n t shall provide the approved funding to the requesting eligible local exchange telecommunications service provider, consistent with the procedures in OAC 165:59-3-68.

(9) Any r e q uest for funds from the OLF will b e returned to the requesting party and deemed denied if the appropriate forms are not used or said forms are not completed in a satisfactory manner.

RECOVERY OF CONTRIBUTION (Reference: OAC 165:59-9-27)

Each contributing provider to the OLF may recover its contributions to th e O LF consistent with 17 O.S. § 139.105. The OLF recovery rece ived by each eligible local exchange telecommunications service provider shall be subject to an annual true-up. Any over- or under-recovery of the Lifeline Service Program contributions for the preceding year shall be carried forward for inclusion in the calculation for recovery in the ensuing year.

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SECTION FOUR

PRIMARY UNIVERSAL SERVICES / REQUEST FOR OUSF FUNDING TEMPLATE

BEFORE THE CORPORATION COMMISSION OF THE STATE OF OKLAHOMA

IN THE MATTER OF THE REQUEST BY ***NAME OF ELIGIBLE TELECOMMUNICATIONS SERVICE PROVIDER*** FOR THE ***INSERT BASIS OF REQUEST*** FOR FUNDING FROM THE OKLAHOMA UNIVERSAL SERVICE FUND

))))))

CAUSE NO. OSF 201XXXXXX

REQUEST FOR OUSF FUNDING

Comes now, ***Eligible Telecommunications Service Provider/ILEC*** and requests reimbursement from the Oklahoma Universal Service Fund (“OUSF”) pursuant to 17 O.S. § 139.106(K).

PARTIES***ILEC***,***Address***,***City, State and Zip*** is an eligible incumbent local

exchange telecommunications service provider serving less that seventy-five thousand access lines. ***ILEC*** is subject to the jurisdiction of the Oklahoma Corporation Commission (“Commission”) and provides Primary Universal Service to customers within its service area pursuant to its lawful authority within the state of Oklahoma.

FACTS

In support of this Request for OUSF Funding (“Request”), ***ILEC*** states as follows:

1. The Oklahoma Telecommunications Act of 1997, signed into law on June 13, 1997 established the OUSF and the Oklahoma Lifeline Fund (“OLF”). Oklahoma Administrative Code (“OAC”) 165:59 was promulgated by the Commission to implement the OUSF and the OLF and to establish guidelines for reimbursement from said funds, and the rules set forth in OAC 165:59 became effective January 6, 1998 and have been amended from time to time since initial approval.

2. ***ILEC’s*** request for reimbursement for Primary Universal Service is sought from the OUSF in the amount of ***$xx,xxx.xx*** pursuant to 17 O.S. § 139.106(K).

3. ***ILEC’s*** has met the eligibility criteria to seek funding through the OUSF

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pursuant to OAC 165:59-3-14 for reimbursement sought for Primary Universal Service.

4. The completed Form PUSF-1 and the Company’s currently effective tariff sheets for local exchange service are attached hereto and incorporated herein by reference.

5. The persons to contact for detailed information regarding this Request for OUSF Funding and information set forth in the attachments is ***Name of Attorney*** for ***ILEC***.

6. The documents listed in the minimum filing requirements, as provided in OAC 165:59-3-70, were provided to the OUSF Administrator concurrently with the filing of this Request.

JURISDICTION

The Commission has jurisdiction in this cause pursuant to OKLA. CONST. art. IX, § 18, 17 O.S. §§ 139.101 et seq. and OAC 165:59.

RELIEF REQUESTED

***ILEC*** requests that the Request for OUSF Funding be granted, as set forth in herein.

Respectfully submitted,

***ILEC***

By: ___________________________________***ATTORNEY NAME ******ADDRESS******PHONE******EMAIL***

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CERTIFICATE OF SERVICE

The undersigned hereby certifies that on this ***date*** day of ***month, year***, a true and correct copy of the foregoing was provided, via email to the following:

Office of Oklahoma Attorney Generalc/o Dara DerryberryAssistant Attorney General313 N.E. 21st StreetOklahoma City, OK [email protected]

Kimberly C. Snyder, Deputy General CounselJudicial and Legislative Services DivisionOklahoma Corporation CommissionP.O. Box 52000Oklahoma City, OK [email protected]

Brandy Wreath, DirectorOUSF Administrator / Public Utility DivisionOklahoma Corporation CommissionP.O. Box 52000Oklahoma City, OK [email protected]

Signed,

___________________________________***CONTACT PERSON’S NAME ******TITLE******PROVIDER******ADDRESS******PHONE******EMAIL***

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SPECIAL UNIVERSAL SERVICES / REQUEST FOR OUSF FUNDING TEMPLATE

BEFORE THE CORPORATION COMMISSION OF THE STATE OF OKLAHOMA

IN THE MATTER OF THE REQUEST BY***NAME OF SCHOOL/LIBRARY/ELIGIBLE HEALTHCARE PROVIDER/CONSORTIUM*** OF ***NAME OF CITY/LIBRARY SYSTEM OR CITY/HEALTHCARE SYSTEM OR CITY/CONSORTIUM LEAD)*** FOR FUNDING FROM THE OKLAHOMA UNIVERSAL SERVICE FUND

))))))))))

CAUSE NO. OSF 201XXXXXX

REQUEST FOR OUSF FUNDING

***Provider*** requests funding from the Oklahoma Universal Service Fund (“OUSF”) pursuant to 17 O.S. § 139.106(D) for its provision of Special Universal Services to ***OUSF Beneficiary*** located at ***street address, city, state and zip***. The organization-location code assigned by the OUSF Administrator is ***location code***.

REQUESTING ENTITY:Contact information for ***Provider*** is:

Contact Name: ***Name***Address: ***Address***

***City, State and Zip***Telephone Number: ***Telephone No.***Email Address: ***e-mail address***

FACTS:In support of this Request for OUSF Funding (“Request”), ***Provider*** states as

follows:

4. ***Provider*** is an Eligible Provider and is entitled to funding from the OUSF for its provision of Special Universal Services pursuant to 17 O.S. § 139.109.1.

5. ***OUSF Beneficiary*** is a (insert one of the following) public school/public library/healthcare entity as defined by 17 O.S. § 139.102.

6. ***OUSF Beneficiary*** is entitled to receive Special Universal Services under 17 O.S. § 139.109.1.

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4. The amount of OUSF funding sought by ***Provider*** is described on Form (insert one of the following depending on whether the request is for school/library or healthcare entity) SUSF-2/SUSF-3, attached hereto and incorporated herein.

5. ***Provider*** acknowledges and certifies that the Special Universal Services includes only the Internet access line, reasonable installation, network termination equipment owned and operated by the Eligible Provider that is necessary to provide the eligible service, and any charges authorized for reimbursement pursuant to the Oklahoma Telecommunications Act.

6. Additional information necessary to support this Request, including the Affidavit of ***OUSF Beneficiary*** in support of Request for Special Universal Services, is being submitted to the OUSF Administrative staff under separate cover.

JURISDICTION:The Commission has jurisdiction in this cause pursuant to OKLA. CONST.

art. IX, § 18, and 17 O.S. §§ 139.101 et seq.

RELIEF REQUESTED:***Provider*** requests that the Request for OUSF Funding be granted, as

set forth in herein.

Respectfully submitted,

***PROVIDER***

By: ___________________________________***ATTORNEY NAME ******ADDRESS******PHONE******EMAIL***

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CERTIFICATE OF SERVICE

The undersigned hereby certifies that on this ***date*** day of ***month, year***, a true and correct copy of the foregoing was provided, via email to the following:

Office of Oklahoma Attorney General Dave Smithc/o Dara Derryberry Sr. IT DirectorAssistant Attorney General Peabody ISD313 N.E. 21st Street [email protected] Oklahoma City, OK [email protected]

Kimberly C. Snyder, Deputy General CounselJudicial and Legislative Services DivisionOklahoma Corporation CommissionP.O. Box 52000Oklahoma City, OK [email protected]

Brandy Wreath, DirectorOUSF Administrator / Public Utility DivisionOklahoma Corporation CommissionP.O. Box 52000Oklahoma City, OK [email protected]

Signed,

___________________________________***CONTACT PERSON’S NAME ******TITLE******PROVIDER******ADDRESS******PHONE******EMAIL***

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SECTION FIVE

Primary Universal Service Request Form (Form PUSF-1)

INTRODUCTION

(1) Applicant is to file the Form PUSF-1 with every Request for OUSF Funding. All supporting work papers are to be provided directly to the PUD and the AG.

(2) Pursuant to OAC 165:59-3-10, the Oklahoma Universal Service Fund (OUSF) is a fund for demonstrated necessity or statutory entitlement. The Primary Universal Service Request Form (Form PUSF-1) should be utilized by an eligible local exchange telecommunications service provider to seek funding from the OUSF to maintain rates for Primary Universal Services that are reasonable and affordable.

(3) Primary Universal Service is defined as:

An access line and dial tone provided to the premises of residential or business customers which provides access to other lines for the transmission of two-way switched or dedicated communication in the local calling area without additional, usage- sensitive charges, including: (A) A primary directory listing; (B) Dual-tone multi-frequency signaling; (C) Access to operator services; (D) Access to directory assistance services; (E) Access to telecommunications relay services for the hearing impaired; (F) Access to nine-one-one service where provided by a local governmental authority or multijurisdictional authority; and (G) Access to interexchange long distance.

(4) It is the intention of the OUSF Administrator that each Request for OUSF Funding will be independently evaluated and reviewed on a case-by-case basis. Part 9 of Subchapter 3 of the OUSF Rules does not purport to predetermine the merits of any Primary Universal Service funding request (OAC 165:59-3-70(e)).

Form PUSF-1 Heading

The Applicant is to indicate if the request is an initial request or a revised request. A revised request is applicable to any changes made to the original/initial request only. Such revisions would generally relate to the resolution of disputes or clarification relating to the previous filing.

Form PUSF-1 Section 1

Lines 1 through 11

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This Section request general information about the “Request for OUSF Funding” including the provider’s name, address, company specific Service Provider Identification Number provided by the Universal Service Administrative Company (USAC), provider and attorney contact information, level of access lines, and under which Chapter 59 rule that funding is being requested.

Lines 12 through 14

Different categories are identified in Form PUSF-1 for use of the Oklahoma Universal Service Fund. Please indicate under which category (I, II, or III) your request for funding is being made and use a separate form for each category of request.

Lines 15 through 17

Three different occurrences are identified in Form PUSF-1 prompting a change in revenues and/or costs. Please indicate which occurrence listed prompted such a change and attach any applicable orders, rules, policies, laws, or other supporting information.


Lines 18 through 27

On line 18, the Applicant is to enter amounts in “column c” that represent one-time or lump sum support payments. Amounts to be reflected in “column d” represent monthly recurring support payment requests. Schedules must be included showing specifically how line item amounts were calculated.

The Applicant is to provide detailed information regarding the changes in cost and/or revenues which resulted in the filing of the Request. The Applicant also must provide a narrative discussing the basis of, the calculations of the changes in revenue and cost. The applicant is to indicate whether the request relates to a one-time lump-sum payment and/or monthly recurring payments by entering amounts in appropriate columns.

Lines 28 through 30

The Applicant is to provide a sufficient and competent level of supporting work papers and documentation in order to fully explain the basis of the request and to show that the level of funding requested is accurate and properly calculated. Schedules must be included showing specifically how line item amounts were calculated. Revenue data should be separated by type.

All work papers and documentation should contain cross-references between schedules and, where appropriate, information taken from the

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underlying costing studies should be cross-referenced as well.

The Applicant should provide a listing of all supporting information, providing directly and exclusively, one electronic copy to the PUD and one electronic copy to the AG. Such information is to be provided to the PUD and the AG concurrently with the filing of the Application seeking Commission approval of a funding request.

The Applicant is to indicate the pricing methodology used for pricing the Primary Universal Service provided, and copies of the cost study must be provided.

Lines 31 and 32

The Applicant is to provide current basic local exchange rates for basic residential and business services as indicated.


Lines 33 and 36The eligible local exchange telecommunications service provider requesting OUSF funding for primary universal service shall make every reasonable and timely effort to obtain funding from alternative funding sources designated to support universal service, and shall submit all documentation of the effort to obtain funding from alternative funding sources designated to support universal service as a part of its Request for OUSF Funding, or an explanation for why alternative funding is not available. Upon the eligible local exchange telecommunications service provider producing the documentation that it has sought alternative funding sources or an explanation for why alternative funding is not available, the eligible local exchange telecommunications service provider shall not be precluded from having its Request for OUSF Funding processed. (OAC 165:59-3-70(g)).

If an eligible local exchange telecommunications service provider receives funding from alternative funding sources for an investment or expense already reimbursed by the OUSF, the eligible local exchange telecommunications service provider shall refund the double collection to the OUSF by either reducing a prospective funding request from the OUSF by an equivalent amount or remitting cash payment to the OUSF. Under no circumstances will double recovery be allowed. (OAC 165:59-3-70(g) & (h)). (OAC 165:59-3-70(h))


Lines 37 and 38

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The company representative’s name and title sponsoring the Form PUSF-1 and their signature and date signed.

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Special Universal Service Request Form (Form SUSF-2)Internet Access for Schools and Libraries

INTRODUCTION

(1) Special Universal Services" means the telecommunications services supported by the OUSF (typically broadband services such as Internet access and Wide Area Network services) which are furnished to public schools, public libraries and eligible health care entities as provided for in 17 O.S. § 139.109.1.

(2) Applicant is to file or submit to PUD copies of all applicable fund request forms with its Request for OUSF Funding. All supporting work papers are to be provided directly to the PUD and the AG. In some instances, the PUD requires the document to be provided in a particular format, such as Excel.

(3) The Public School/District and Library Affidavits in Section 8, Attachment 4 – Demarcation Point(s) request the school or library to provide the demarcation point address for each Internet access and WAN circuit. The demarcation point being requested is the demarcation point associated with the service for which OUSF funding is being requested.

(4) The School and Library SUSF-2 and Affidavit are available using the following web link: http://www.occeweb.com/pu/OUSF/OUSF.htm, then by choosing the applicable Form and Affidavit from the School or Library section.

Form SUSF-2 Section 1

Lines 1 through 11This Section request general information about the “Request for OUSF Funding”. The Applicant is to provide the full Company name and the Company Specific Code provided by PUD/GVNW for the Applicant along with the Company’s address, contact information including person’s name, e-mail address and phone number, as well as the attorney’s names and contact information.


Lines 12 through 17The Applicant is to provide information indentifying the beneficiary, including the school district’s or library’s name and address as well as the Org-location code assigned by PUD.


Lines 18 through 20The amount to be reflected o n l i n e 1 8 i s t h e one-time o r lump sum support payment. Generally the lump sum amount is equal to the monthly payment amount times the number of months service was provided since installation of the

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service up to the date that the Request for OUSF Funding is filed. Amounts to be reflected in “column b” represent monthly recurring support payment requests. Schedules (SUSF-2 Spreadsheet) must be included showing specifically how line item amounts were calculated.

Under “Optional Comments” one line 18, the Applicant should indicate specifically what is the “Lump Sum Period, and on line 19 indicate when the Monthly Recurring payment is requested to begin.


Lines 21 and 22This is to indicate whether this Request for OUSF Funding is associated with “Preapproval” and if so and the service and/or bandwidth in the Preapproval Funding Letter do not match this Request then provide an explanation of why they are different.

Form SUSF-2 Section 5 Line 23

This is simply space given for the Applicant to provide any additional comments related to the Request for OUSF Funding.

Form SUSF-2 Section 6 Lines 24 through 27

This space is provided for the name, title, and signature of the Company representative sponsoring this Form SUSF-2, as well as the date it was signed.

School and Library Affidavit

Affidavit in Support of Request for Special Universal Services (Affidavit) is available at http://www.occeweb.com/pu/OUSF/OUSF.htm

Applicant is to file copies of all applicable documents with its application. All supporting work papers are to be provided directly to the PUD and the AG. In some instances, the PUD requires the document to be provided in a particular format, such as Excel.

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Special Universal Service Request Form (Form SUSF-3)Telemedicine for Healthcare Providers

INTRODUCTION

(1) Special Universal Services" means the telecommunications services supported by the OUSF (typically broadband services for the provision of telemedicine services) for eligible healthcare providers as provided for in 17 O.S. § 139.109.1.

(2) Applicant is to file or submit to PUD copies of all applicable fund request forms with its Request for OUSF Funding. All supporting work papers are to be provided directly to the PUD and the AG. In some instances, the PUD requires the document to be provided in a particular format, such as Excel.

(3) The Eligible Healthcare Entity Affidavit in Section 8, Attachment 1 – License/Certifications request the Healthcare Provider (“HCP”) provide its qualification/verification as part of a consortium, if any. One means to verify the requesting HCP is a part of a consortium recognized by Universal Service Administrative Company is to submit a copy of USAC’s Consortium Letter of Agency.

(4) The Eligible Healthcare Entity Affidavit in Section 8, Attachment 8 – Demarcation Point(s) request HCP to provide the demarcation point address for each Internet access and WAN circuit. The demarcation point being requested is the demarcation point associated with the service for which OUSF funding is being requested.

(5) The Telemedicine SUSF-3 and Affidavit are available using the following web link: http://www.occeweb.com/pu/OUSF/OUSF.htm, then by choosing the applicable Form and Affidavit from the Healthcare/Telemedicine section.


Lines 1 through 11

This Section request general information about the “Request for OUSF Funding” including the provider’s name, company code assigned by PUD/GVNW, provider’s address, contact name and attorney for the provider with e-mail and phone numbers.


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The Applicant is to provide the full Company name and the Company Specific Code provided by PUD/GVNW for the Applicant along with the Company’s address, contact information including person’s name, e-mail address and phone number, as well as the attorney’s names and contact information.


Lines 18 through 20The amounts to be reflected o n l i n e 1 8 i s t h e one-time o r lump sum support payment. Generally the lump sum amount is equal to the monthly payment amount times the number of months service was provided since installation of the service up to the date that the Request for OUSF Funding is filed. Amounts to be reflected in “column b” represent monthly recurring support payment requests. Schedules (SUSF-3 Spreadsheet) must be included showing specifically how line item amounts were calculated.

Under “Optional Comments” one line 18, the Applicant should indicate specifically what is the “Lump Sum Period, and on line 19 indicate when the Monthly Recurring payment is requested to begin.


Lines 21 and 22

This is to indicate whether this Request for OUSF Funding is associated with “Preapproval” and if so and the service and/or bandwidth in the Preapproval Funding Letter do not match this Request then provide an explanation of why they are different.

Form SUSF-3 Section 5 Line 23 is simply space given for the Applicant to provide any additional comments related to the Request for OUSF Funding.


This space is provided for the name, title, and signature of the Company representative sponsoring this Form SUSF-3, as well as the date it was signed.

Telemedicine Affidavit

Affidavit in Support of Request for Special Universal Services (Affidavit) is available at http://www.occeweb.com/pu/OUSF/OUSF.htm

Applicant is to file copies of all applicable documents with its application. All supporting work papers are to be provided directly to the PUD and the

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AG. In some instances, the PUD requires the document to be provided in a particular format, such as Excel.

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Oklahoma Universal Service Request Form (Form OLF - 1)Lifeline Reimbursement Request

INTRODUCTION

(1) Applicant is to file copies of all applicable fund request forms with its Request for OLF Funding.

(2) All supporting work papers are to be provided directly to the PUD and the AG.

(3) The Oklahoma Universal Service Fund Lifeline Reimbursement Request Form OLF-1 is available at the following web link: http://www.occeweb.com/pu/OUSF/OUSF.htm,

(4) A Form OLF-1 must be submitted for each month in which funding is being requested.

Form OLF-1 Header Submission Date is the date the reimbursement request is filed. Data Month is the month during which service was provided to the Lifeline subscribers included in Section 1.

Form OLF-1 Section 1 Lines 1 through 8

The Applicant is to provide the full Company name and the Company Specific Service Provider Identification provided by the Universal Service Administrative Company (USAC) for the Applicant and general contact information.


The OLF support is limited to $0.02 per line, per month. In this Section the Applicant is to list the number of access lines by each eligibility category for which funding is being requested and the total amount of OLF funding being requested for each eligibility category. Line 23 is the total number of access lines associated with the request and the total amount of OLF funding being requested for the month. A Form OLF-1 must be submitted for each month in which funding is being requested.

The Applicant must also maintain on file, at the office location, a copy of all certification relied upon to support the eligibility of the individuals associated with the access lines reflected on the form.

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Form OLF-1 Section 3Lines 24 through 27

The eligible local exchange telecommunications service provider shall make every reasonable and timely effort to obtain funding from alternative or additional funding sources designated to support Lifeline Universal Service. However, such efforts shall not delay the company’s ability to pursue funding from the OLF. If an eligible local exchange telecommunications service provider receives funding from alternative funding sources for an investment or expense already reimbursed by the OLF, the company shall reduce the amount of any prospective funding request from the OLF by an equivalent amount. Under no circumstances will double recovery be allowed. (OAC 165:59-3-62(d)) Receipt of funding from the federal Universal Service Fund for the provision of Lifeline service is not considered double recovery.

The Applicant should specifically indicate, yes or no, if it has, or intends to, request funding support from all possible alternative or addi t ional funding sources designated to support Universal Service. If “no” then the applicant should explain why.

The Applicant is to indicate, and if applicable provide details regarding, any funding support actually received from an alternative source. The Applicant should also indicate and discuss any notification received from an alternative funding source indicating that funding will be received.

Form OLF-1 Section 4 Line 28 is simply space given for the Applicant to provide any additional comments related to the Request for OUSF Funding.


This space is provided for the name, title, and signature of the Company representative sponsoring this Form OLF-1, as well as the date it was signed.

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