Instructions for Completing the Universal Service Administrative
Company\'s

# Service Provider Information Form

[I INTRODUCTION]{.underline}

On May 8, 1997, the Commission released a Report and Order on Universal
Service (Universal Service Order) in CC Docket No. 96-45 that
established new federal universal service support mechanisms, consistent
with the universal service provisions contained in section 254 of the
Communications Act of 1934, as amended. In the Order on Reconsideration
in CC Docket No. 96-45 (rel. July 10, 1997), the Report and Order and
Second Order on Reconsideration in CC Docket Nos. 97-21 and 96-45 (rel.
July 18, 1997), the Order on Reconsideration, Second Report and Order,
and Further Notice of Proposed Rulemaking in CC Dockets 97-21 and 96-45
(rel. August 15, 1997), the Third Report and Order in CC Docket 96-45
(rel. October 14, 1997), and the Fourth Order on Reconsideration in CC
Docket No. 96-45, Report and Order in CC Docket Nos. 96-45, 96-262,
94-1, 91-213, 95-72 (rel. December 30, 1997), the Commission
reconsidered certain aspects of the Universal Service Order.

In connection with the universal service proceeding, the Commission
appointed the Universal Service Administrative Company (USAC) as
temporary administrator of certain portions of the universal service
support mechanisms, including portions of the schools and libraries and
rural health care programs. One of the functions of USAC is to provide a
mechanism for the billing and collection of funds for the schools and
libraries and rural health care programs.

Pursuant to sections 54.515 and 54.611 of the Commissions rules, 47
C.F.R. §§ 54.515 and 54.611, USAC must obtain information relating to:
service provider name and address, telephone number, Federal employer
identification number, contact names and telephone numbers, and billing
and collection information.

To that end, USAC has developed a Service Provider Information Form,
Form 498, to collect this information from carriers and service
providers participating in the schools and libraries and rural health
care programs.

This document provides instructions for completing the Service Provider
Information Form, Form 498. This form should be completed by each
service provider receiving universal service support under the schools
and libraries and rural health care programs. The pre-assigned service
provider number is included on the transmittal letter with this form.
The form will be used to supplement the service provider number with the
following information: service provider name, address, telephone phone
numbers, contact names and telephone numbers, and billing and collection
information. USAC will use this information in administering the billing
and collection operations of the universal service support mechanisms.

[II FILING REQUIREMENTS AND GENERAL INSTRUCTIONS]{.underline}

A. [Who should file.]{.underline}

All service providers participating in schools and libraries and rural
health care universal service programs should file a Service Provider
Information Form, Form 498.

One of the uses of the data on this form is to enable USAC to offset a
contributor\'s invoices related to providing services to schools,
libraries, and rural health care providers against its universal service
contribution obligation. Each contributor and each contributor's
business unit should complete a Service Provider Information Form, Form
498. For each contributor's business unit(s) for which we are not able
to pre-assign a service provider number, USAC will assign a number upon
receipt of a completed Form 498. Copies of the Form 498 may be
reproduced and completed for as many business units providing service.
[For a contributor]{.underline}, the USAC service provider number in
item 3 and item 29 will be the same. [For a business unit of a
contributor]{.underline}, the USAC service provider number in item 29
will be the same as the service provider number in item 3 of the
contributor's Form 498. It is important that the contributor and the
business unit(s) of the contributor coordinate the completion of their
respective forms.

B. [When and Where to File.]{.underline}

The Service Provider Information Form, Form 498 is to be completed by
the service provider within five days of receipt and must be accompanied
by a letter of authorization on company letterhead (see attachment A of
the instructions to this form) and forwarded to:

Universal Service Administrative Company

> Attn: Billing and Disbursement
>
> P.O. Box 223164

Chantilly, VA 20153-3164

C. [Where to get more information?]{.underline}

Any questions that the service provider has when completing this form
may be directed to the USAC administrator at :

> **888-641-8722 or FAX 888-637-6226**

[III SPECIFIC INSTRUCTIONS]{.underline}

The following section requests billing and collection information about
the service provider participating in universal service programs.

A. [Block 1: General Information]{.underline}

Block 1 of Form 498 requests the name of your company, a USAC service
provider number, address, and Federal employer identification number (if
you are not a corporation).

**Item (1), Full Legal Name of Service Provider -** The full legal name
of the company providing service as it appears on articles of
incorporation, registration or other legal documents.

**Item (2), TRS Company Code -** Provide the TRS Company Code as it
appears on the FCC Form 457 (applicable only for eligible
telecommunication carriers).

**Item (3), Service Provider Number --** Leave this field blank if this
is the initial submission of a new Form 498. When your form is received
by USAC, a number will be assigned to your company and USAC will notify
you, within 48 hours, of the assigned number. For all other submissions
of Form 498 (e.g., revisions to original data), please include your
previously assigned Service Provider Identification Number (SPIN).
Revisions to previously filed information cannot be processed without
the SPIN number.

**Item (4), Principal Communications Business -** Provide the principal
communications business code which best describes the service provider's
business activity. For service providers that are contributors to the
Universal Service fund (file a FCC Form 499), this principal business
activity code should correspond to the service providers business
activity indicated on their FCC Form 499. The principal communications
business code should be selected from the following list:

[Code]{.underline} [Description]{.underline}

TEN Shared Tenant Service Provider - manages or owns a multi-tenant
location that provides telecommunications services or facilities to the
tenants for a fee.

PAY Payphone Service Provider - provides customers access to telephone

networks through pay telephone equipment, special teleconference rooms,
etc. Payphone service providers are also referred to as pay telephone
aggregators.

PRIV Private Service Providers - offers telecommunications to others for
a fee. This would include a company that offers excess capacity on a
private system that is used primarily for internal purposes.

LEC Incumbent LEC - provides local exchange service. An incumbent local

exchange carrier (ILEC) generally is a carrier that was at one time

franchised as a monopoly service provider.

CAP CAP/CLEC (Competitive Access Provider/Competitive Local Exchange

Carrier) - competes with incumbent LEC's to provide local exchange
services or telecommunications services that link customers with
interexchange facilities, local exchange networks, or other customers.

LRES Local reseller - provides local exchange or fixed
telecommunications

services by reselling services of other carriers.

CEL Cellular/PCS/SMR (Cellular, Personal Communications Service and

Specialized Mobile Radio service providers) - primarily provides
wireless telecommunications services (wireless telephony). This category
includes the provision of wireless telephony by resale. An SMR provider
would select this category if it primarily provides wireless telephony
rather than dispatch or other mobile services.

PAG Paging and Messaging - provide wireless paging or wireless messaging

services. This category includes the provision of paging and messaging
services by resale.

DAT Wireless Data - provides mobile or fixed wireless data services
using

wireless technology. This category includes the provision of wireless
data services by resale.

[Code]{.underline} [Description]{.underline}

IXC IXC (Interexchange Carrier) - provides long distance
telecommunications

services substantially through switches or circuits that it owns or
leases.

TRES Toll Reseller - provides long distance telecommunications services
primarily by reselling the long distance telecommunications services of
other carriers.

OSP OSP (Operator Service Provider) - companies other than incumbent

LEC's that serve customers needing the assistance of an operator to

complete calls, or needing alternate billing arrangements.

SAT Satellite - provides satellite space segment or earth stations that
are used

for telecommunications service.

PRE Pre-paid Card - provides pre-paid calling card services by selling
pre-

paid calling cards to the public or to retailers. Pre-paid card
providers typically resell the toll service of other carriers and
determine the price of the service by setting the price of the card and
controlling the number of minutes that the card can be for.

SMR SMR (dispatch) (Specialized Mobile Radio service provider) --
primarily

provides dispatch and mobile services other than wireless telephony.

OTHL Other Local - telecommunication companies that provide local
service

and do not conform to one of the above categories.

OTHM Other Mobile - telecommunication companies that provide mobile

service and do not conform to one of the above categories.

OTHT Other Toll - telecommunication companies that provide toll service

and do not conform to one of the above categories.

ISP Internet Service Provider - providers of access to the Internet.

NTP Non-traditional Provider - if you are a company that does not
provide telecommunication services.

**Item (5), Service Provider's Address -** Provide the service
provider's full mailing address, whether a street address, Post Office
Box number, or route number and city, state and zip code.

**Item (6), Federal Employer Identification Number -** Enter the Federal
employer identification number. If you do not have a Federal employer
identification number, enter your social security number.

**Item (7), Business Structure -** Check one of the three boxes
indicating whether the service provider is a corporation, partnership or
other.

**Items (8, 9 & 10), Service Provider's Contact -** Provide the name,
phone number and facsimile number for the person that should be
contacted with questions regarding the billing and collection of funds
for the service provider.

**Item (11 & 11a), Address of Service Provider's Contact -** Provide the
Service Provider's contact persons full mailing address, whether a
street address, Post Office Box number, or route number and city, state
and zip code. Also provide an E-mail Address if available.

B. [Block 2: Schools & Libraries and Rural Health Care
Information]{.underline}

Block 2 requires you to identify contacts and payment information for
the schools and libraries and rural health care programs.

> Service Provider's Schools and Libraries and Rural Health Care Program
> Contacts

**Item (12, 13 & 14), Service Provider's Schools and Libraries Program
Contact -** Provide the name, phone number and facsimile number of the
service provider's contact person who will receive correspondence and
answer questions regarding the Schools and Libraries program.

**Item (15), Address of Service Provider's Schools and Libraries Program
Contact -** Provide the contact person's name listed above, along with
his or her full mailing address, whether a street address, Post Office
Box number, or route number and city, state and zip code. The address
provided will be the address the Schools and Libraries Corporation uses
for all correspondence to the service provider.

**Item (16, 17 & 18), Service Provider's Rural Health Care Program
Contact -** Provide the name, phone number, and facsimile number of the
service provider's contact person who will receive correspondence and
answer questions regarding the rural health care program.

**Item (19), Address of Service Provider's Rural Health Care Program
Contact -** Provide the contact person's name listed above and his or
her full mailing address, whether a street address,

Post Office Box number, or route number and city, state and zip code.
The address provided will be the address the Rural Health Care
Corporation uses for all correspondence to the service provider.

Schools & Libraries and Rural Health Care Payment Information

In accordance with section 54.515 of the Commission\'s rules, USAC, at
the service provider\'s request, will offset the service provider
schools and libraries invoices against the provider's universal service
support contribution obligation. In accordance with section 54.611 of
the Commission\'s rules, USAC will offset the service provider\'s rural
health care invoices against the provider's universal support
contribution obligation.

Note: The service provider must indicate (by checking the appropriate
box) whether or not they are requesting to have their schools and
libraries invoices offset against the provider's universal service
obligation.

The information provided here will be used when issuing payments for
services provided and when offsetting the invoices of the contributor's
business unit(s) against the contributor's obligation. All
telecommunications carriers that provide interstate telecommunications
services, providers of interstate telecommunications that offer services
to others for a fee, and pay telephone aggregators must contribute to
the universal service support mechanisms based on their proportionate
share of end-user telecommunications revenues. (See Telecommunications
Reporting Worksheet, FCC Form 499).

> [General instructions for completing items 20 through 33.]{.underline}
>
> **- If you are a contributor**, complete items 20 through 33.
>
> **- If you are a business unit of a contributor and [are]{.underline}
> requesting to have your schools and libraries invoices offset against
> the contributor's universal service obligation** ([i.e., the **YES**
> box on the form is checked]{.underline}), complete items 27 through 33
> only.
>
> **- If you are a business unit of a contributor and [are
> not]{.underline} requesting to have your**
>
> **Schools & Libraries invoices offset against the contributor's
> universal service obligation** (i.e., [the **NO** box on the form is
> checked]{.underline}), complete items 20 through 33.
>
> **- If you are not a contributor and not a business unit of a
> contributor**, complete items 20 through 26 only.

**Item (20), Name of Remittance Company -** Provide the name of the
company to which funds will be remitted for services rendered, to the
Schools and Libraries and Rural Health Care Corporations, by the service
provider.

**Item (21), Address of Remittance Company -** Provide the full mailing
address, street address, Post Office Box number, or route number and
city, state and zip code of the company receiving funds for the service
provider.

**Item (22, 23 & 24), Remittance Contact -** Provide a contact person's
name, phone number and facsimile number for the person that will answer
questions regarding the remittance of funds to the service provider.

**Item (25), Name of Remittance Bank -** This item is required only for
those service providers electing Automatic Clearing House (ACH) or lock
box transfer of funds.

**Item (26), Remittance Clearing House (ACH) Number And Bank Account -**
This item is required only for those service providers electing
Automatic Clearing House (ACH) transfer of funds. Provide the ACH bank
transit number and bank account number.

**Item (27), Name of Contributor Company -** Provide the name of the
organization that renders payment, either on its own or on behalf of
affiliated business unit(s) and service provider subsidiaries, of
universal service contribution obligations.

**Item (28), Contributors TRS Company Code -** Provide the
contributor\'s Form 499 TRS code (the six digit TRS code starting with
an "8").

**Item (29), Service Provider Number of Contributor Company -** Enter
the USAC service provider number for the contributor company. If this
form is being completed by the contributor company, the USAC service
provider number entered for this item should be the same as that on item
3 of this form. If this form is being completed by a business unit of a
contributor company, the USAC service provider number entered for this
item should be the same as item 3 on the Form 498 completed by the
affiliated contributor company. **It is important that the contributor
and the business unit(s) of the contributor coordinate the completion of
their respective forms.**

**Item (30), Address of Contributor Company -** Provide the contributor
company's full mailing address, whether a street address, Post Office
Box number, or route number and city, state and zip code.

**Item (31, 32 & 33), Contributor Company Contact -** Provide the name,
phone number and facsimile number for the person that should be
contacted with questions regarding the billing and

collection of funds for the contributor company.

**Item (34), Filing Status -** The service provider should indicate, by
checking the appropriate box, whether the form is an original
application or whether revisions are required on previously provided
information. To initiate revisions, Block 1, General Information, must
be completed. Only the specific line items that are being revised should
be completed. All originals and revisions must be accompanied by a
letter of authorization on company letterhead. It is incumbent upon the
service provider to keep the information on this form current as it may
affect the timeliness of payment.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Notice:** The Federal Communications Commission has designated the
Universal Service Administrative Company (USAC) as temporary
administrator of the universal service support mechanisms for schools &
libraries and rural health care programs. One of the functions of USAC
is to provide a mechanism for the billing and collection of funds for
the various programs. In an effort to implement these requirements and
obligations, the Commission has adopted this collection of information.
Pursuant to sections 54.515 and 54.611 of the Commissions rules, 47 CFR
Sections 54.515 and 54.611, USAC must obtain information relating to:
service provider name and address, telephone number, Federal employee
identification number, contact names and telephone numbers, and billing
and collection information. This form should be completed by each
service provider receiving universal service support under the schools
and libraries and rural health care programs. USAC will use this
information in administering the billing and collection operations of
the universal service support.

**Remember \--** You are not required to respond to a collection of
information sponsored by the Federal government, and the government may
not conduct or sponsor this collection, unless it displays a currently
valid Office of Management and Budget (OMB) control number. This
collection has been assigned an OMB control number of 3060-0824.

We have estimated that each response to this collection of information
will take, on average, 1 hour. Our estimate includes the time to read
the instructions, look through existing records, gather and maintain the
required data, and actually complete and review the form or response. If
you have any comments on this estimate, or how we can improve the
collection and reduce the burden it causes you, please write the Federal
Communications Commission, AMD-PERM, Washington, D.C. 20554, Paperwork
Reduction Project (3060-0824). We also will accept your comments via
Internet if you send them to jboley@fcc.gov. Please DO NOT SEND
COMPLETED FORMS TO THIS ADDRESS.

The foregoing Notice is required by the Privacy Act of 1974, P.L.
93-579, December 31, 1994, 5 U.S.C. 552a(e)(3), and the Paperwork
Reduction Act of 1995, P.L. 104-13, 44 U.S.C. Section 3501.

The Commission is authorized under the Communications Act of 1934, as
amended, to collect the personal information we request in this form. We
will use the information that you provide for billing and collection
purposes. If we believe there may be a violation or potential violation
of a statute or a Commission regulation, rule or order, your form may be
referred to the Federal, state, or local agency responsible for
investigating, prosecuting, enforcing, or implementing the statute,
rule, regulation, or order. In certain cases, the information in your
Form may be disclosed to the Department of Justice, court, or other
adjudicative body when (a) the Commission; or (b) any employee of the
Commission; or (c) the United States government, is a party to a
proceeding before the body or has an interest in the proceeding.

If you owe a past due debt to the federal government, the taxpayer
identification number (such as your social security number) and other
information you provide also may be disclosed to the Department of the
Treasury Financial Management Service, other Federal agencies, and/or
your employer to offset your salary, IRS tax refund, or other payments
to collect that debt. The Commission also may provide this information
to those agencies through the matching of computer records where
authorized.

Attachment A

\[ COMPANY LETTERHEAD \]

Date

USAC Database Administration

P.O. Box 223164

Chantilly, VA 20153-3164

I certify that I have provided the information on the attached Service
Provider Information Form and to the best of my knowledge, information
and belief, all information contained in this form is true and that said
form is an accurate statement of the affairs of the above-named service
provider.

Service Provider Number \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Printed name of authorized person
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title or position of authorized person
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_