**FCC Form 471** Approval by OMB

3060-0806

**Schools and Libraries Universal Service**

**Services Ordered and Certification Form**

Estimated Average Burden Hours Per Response: 4 hours

**Instructions for Completing the**

**Schools and Libraries Universal Service**

**Services Ordered and Certification Form (FCC Form 471)**

**CONTENTS**

**Key Information page 1**

**Notice page 2**

I.  **Introduction page 3**

II. **Filing Requirements and General Instructions page 3**

III. **Minimum Processing Standards and Filing Requirements page 6**

IV. **Specific Instructions page 9**

V.  **Reminders page 31**

**NOTICE**

Section 54.504 of the Federal Communications Commission's (FCC) rules
requires all schools and libraries ordering services that are eligible
for universal service discounts to file this Services Ordered and
Certification Form (FCC Form 471) with the Universal Service
Administrator, which is the Schools and Libraries Division (SLD) of the
Universal Service Administrative Company (USAC). 47 C.F.R. § 54.504. For
purposes of this form, the Universal Service Administrator will be
referred to as the "SLD" or "Fund Administrator." The collection of
information stems from the Commission\'s authority under Section 254 of
the Communications Act of 1934, as amended, 47 U.S.C. § 254. The data
collected in Form 471 will be used to ensure that schools and libraries
are receiving the appropriate discounts, complying with the eligibility
requirements in 47 C.F.R. § 54.501, and taking steps required by 47
C.F.R. § 54.504 that are necessary to use the discounted services
effectively. All schools and libraries ordering services eligible for
universal service discounts must file this form, individually or as part
of a consortium.

The FCC is authorized under the Communications Act of 1934, as amended,
to collect the information we request in this form. We will use the
information you provide to determine whether approving this application
is in the public interest. If we believe there may be a violation or
potential violation of any statute, regulation, rule or order, your
application 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 application may be disclosed to the Department of
Justice or a court or adjudicative body when (a) the FCC; or (b) any
employee of the FCC; or (c) the United States Government, is a party of
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 and other information you provide may also 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 FCC
may also provide this information to these agencies through the matching
of computer records when authorized. In addition, consistent with the
Communications Act of 1934, FCC regulations and orders, the Freedom of
Information Act, 5 U.S.C. § 552, or other applicable law, information
provided in or submitted with this form or in response to subsequent
inquiries may be disclosed to the public.

If you do not provide the information requested on this form, the
processing of your application may be delayed or your application may be
returned to you without action.

The foregoing Notice is required by the Paperwork Reduction Act of 1995,
Pub. L. No. 104-13, 44 U.S.C. § 3501, *et seq.* An agency may not
conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB
control number.

Public reporting burden for this collection of information is estimated
to average four hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, completing, and reviewing the collection of
information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for
reducing the reporting burden, to the Federal Communications Commission,
Performance Evaluation and Records Management Branch, Washington, D.C.
20554.

**I. INTRODUCTION**

On May 7, 1997, the FCC adopted rules providing discounts on all
telecommunications services, Internet access, and internal connections
for all eligible schools and libraries. Section 54.504 of the FCC's
rules require all eligible schools and libraries ordering services under
this discount mechanism to certify their eligibility to receive
discounts. 47 C.F.R. § 54.504. Section 54.504 of the FCC's rules directs
schools and libraries to submit this information on a Services Ordered
and Certification Form. 47 C.F.R. § 54.504.

**II. FILING REQUIREMENTS AND GENERAL INSTRUCTIONS**

**A. Who Must File**

Form 471 must be filed to request discounts on eligible services for
eligible schools, libraries, and consortia of those entities. Form 471
must be filed AFTER an FCC Form 470, which must be posted on the SLD web
site for at least 28 days before the Form 471 is filed. This 28-day
waiting period must occur before you may execute any contracts for
contracted services; before you select your service provider for
tariffed or month-to-month services; and before you sign and submit your
Form 471. It is possible that a Form 470 posted in a prior funding year
may be used where such a form resulted in a multi-year contract. (See
Form 470 Instructions.)

**EACH BILLED ENTITY MUST FILE A FORM 471 APPLICATION.** Thus, even if
several billed entities together filed a single Form 470, each billed
entity must file a separate Form 471.

**IMPORTANT NOTE:** An entity is considered a "billed entity" if it is
responsible for making payments directly to a service provider. An
entity that receives a bill, but does not make payments to the service
provider on that bill, is not a billed entity. **A billed entity may or
may not itself qualify for discounts under the universal service support
mechanism for schools and libraries.**

For purposes of the schools and libraries universal service support
mechanism, schools must meet the statutory definition of elementary and
secondary schools found in the **No Child Left Behind Act of 2001, 20
U.S.C. § 7801(18) and (38)**. An elementary school is a non-profit
institutional day or residential school, including a public elementary
charter school, that provides elementary education, as determined under
state law. 47 C.F.R. § 54.500(b) and 20 U.S.C. § 7801(18). A secondary
school is a non-profit institutional day or residential school,
including a public secondary charter school, that provides secondary
education, as determined under state law, except that such term does not
include any education beyond grade 12. 47 C.F.R. § 54.500(j) and 20
U.S.C. § 7801(38). In addition, eligible elementary and secondary
schools may not have endowments exceeding \$50 million. 47 C.F.R. §
54.501(b)(3).

Libraries must meet the statutory definition of library or library
consortium found in the Library Services and Technology Act, Pub. L. No.
104-208, sec. 211 *et seq.*, 110 Stat. 3009 (1996) (LSTA), and must be
eligible for assistance from a state library administrative agency under
that Act. A library includes: "(1) a public library; (2) a public
elementary school or secondary school library; (3) an academic library;
(4) a research library, which for the purposes of this definition means
a library that: (i) makes publicly available library services and
materials suitable for scholarly research and not otherwise available to
the public; and (ii) is not an integral part of an institution of higher
education; and (5) a private library, but only if the state in which
such private library is located determines that the library should be
considered a library for purposes of this definition." 47 C.F.R. §
54.500(c). A library\'s eligibility for universal service funding also
depends on its funding as an independent entity. **Only libraries whose
budgets are completely separate from any schools' (including, but not
limited to, elementary and secondary schools, colleges, and
universities) shall be eligible to receive discounted services under the
universal service support mechanism.** 47 C.F.R. § 54.501(c)(2). For
example, an elementary school library would only be eligible to receive
discounted services if its budget were completely separate from the
elementary school. If its budget were not completely separate from the
elementary school, the elementary school library would not be eligible
for support independent from the school with which it is associated.

A library consortium is "any local, statewide, regional, or interstate
cooperative association of libraries that provides for the systematic
and effective coordination of the resources of schools, public,
academic, and special libraries and information centers, for improving
services to the clientele of such libraries." 47 C.F.R. § 54.500(d).

**B. When, Where, and How Many Forms 471 to File**

Form 471 must be preceded by the filing and posting of a Form 470 **for
at least 28 days**.

For newly contracted, tariffed, or month-to-month services, please note
that the EARLIEST date on which you may choose vendors or execute
contracts or service agreements for those services (the Allowable Vendor
Selection/Contract Date) will be expressly identified in a letter sent
to each current-year Form 470 applicant to acknowledge the Fund
Administrator's receipt of the Form 470 application. The Allowable
Vendor Selection/Contract Date will also be indicated on the Form 470
posted on the SLD web site.

The earliest date that a Form 471 can be filed will be the date
established by the Fund Administrator as the opening of the Form 471
application filing "window." The Form 471 application filing window is
the period during which applications will be considered as having
arrived simultaneously. All Forms 471, including certifications,
received or postmarked by the close of the application filing window are
considered as if they had arrived on the same day, and have priority
over those postmarked after the closing date of the "window." For
Funding Year 2003, the application filing window will open at noon EST
on Monday, November 4, 2002 and close at 11:59 p.m. EST on January 16,
2003.

The Form 471 may be filed either manually (on paper) or electronically
(online). No Forms 471 will be accepted if sent to the SLD via e-mail or
fax.

-   ***If You Are Filing on Paper:*** You may complete and submit the
    Form 471 by filing a paper copy of the completed form, including the
    completed and signed Block 6 Certifications and any attachment(s),
    with the Fund Administrator. The signed Form 471 must be filed with
    the Fund Administrator **at the address listed at the bottom of the
    form: SLD-Form 471, P.O. Box 7026, Lawrence, Kansas 66044-7026**.
    For express delivery or U.S. Postal Service Return Receipt, send to:
    **SLD-Form 471, c/o Ms. Smith, 3833 Greenway Drive, Lawrence, Kansas
    66046**, phone 1-888-203-8100. DO NOT FILE THIS OR ANY OTHER
    UNIVERSAL SERVICE FORM WITH THE FEDERAL COMMUNICATIONS COMMISSION.

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-   ***If You Are Filing Online:*** You may complete and submit the Form
    471 by filing the Form online at the SLD web site
    www.sl.universalservice.org. If filing your Form 471 online, you
    must also complete and submit to the SLD the following documents in
    order to successfully complete the submission of your Form 471
    application:

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-   the Item 21 description(s) of services, and

-   the Block 6 Certification with the signature of the authorized
    person (whether online or on paper)

-   You may qualify to submit your Form 471 certifications online. When
    you submit your certifications online, you will receive a
    confirmation so that you can be assured that your submission has met
    any filing deadlines. Check the SLD web site for information about
    obtaining a User ID and a PIN.

    You may file more than one Form 471. For example, you may file one
    Form 471 for Internal Connections, one for Internet Access, and one
    for Telecommunications Services. As the billed entity for services
    requested on one or more Forms 470, you may combine services
    requested on multiple Forms 470 into one Form 471, or you may file a
    corresponding Form 471 for each Form 470 filed. Please refer to the
    detailed instructions for more information about these procedures.

    **NOTE: Applicants who are applying for both Priority 1
    (Telecommunications Services or Internet Access) and Priority 2
    (Internal Connections) services are strongly encouraged to file
    these requests on separate Forms 471 --- that is, to file one or
    more Forms 471 for their Priority 1 requests and one or more Forms
    471 for their Priority 2 requests. This separation will allow the
    SLD to process Priority 1 requests and communicate decisions on
    funding commitments for those requests more quickly. Because there
    is often uncertainty about the funding threshold for Internal
    Connections, applicants who combine funding requests for Priority 1
    and Priority 2 services on a single Form 471 risk delaying the
    notification process for Priority 1 funding decisions.**

# **Assistance in Completing This Form**

There are several sources of assistance to guide you in completing this
form. If you complete this Form online at the SLD web site at
www.sl.universalservice.org, you will be assisted in the process by
special step-by-step online instructions. Whether you file online or on
paper, you are urged to consult the Reference Area of the SLD web site,
www.sl.universalservice.org, for guidance in completing this form. Those
without web access may obtain similar guidance material by calling the
SLD Client Service Bureau via toll-free telephone at **1-888-203-8100.**
Further information is also available from the SLD Client Service Bureau
at **1-888-203-8100**, via e-mail at **question@universalservice.org**,
or via fax at **1-888-276-8736**.

**D. Compliance**

Schools and libraries, or consortia acting on behalf of schools and
libraries, failing to file the Services Ordered and Certification Form
(Form 471) will not be eligible to receive universal service discounts.
Schools and libraries filing false information are subject to fines
under Section 502 of the Communications Act, 47 U.S.C. § 502, forfeiture
penalties under Section 503(b) of the Communications Act, 47 U.S.C. §
503(b), or penalties for false statements under Title 18 of the United
States Code, 18 U.S.C. § 1001. Applicants should retain the worksheets
and other records they use to compile these forms for five years. This
includes all documentation showing that you have complied with all
applicable competitive bidding requirements, including copies of
competing bids and documentation of the bid evaluation process and bid
criteria used. Thus, if applicants represent multiple billed entities,
collect data from those entities, and add up that data, they should
retain those data sheets for five years. If an applicant is audited, it
should be prepared to make the worksheets and other records used to
compile these forms available to the auditor and/or the Administrator,
and it should be able to demonstrate to the auditor and/or the
Administrator how the entries in its application were provided.

III. **MINIMUM PROCESSING STANDARDS AND FILING REQUIREMENTS**

**Form 471 Minimum Processing Standards**

When a Form 471 is submitted on paper and received by the SLD, the form
is first reviewed to make sure it complies with the following
requirements before data entry begins. These minimum processing
requirements are necessary in order to ensure the timely and efficient
processing of properly completed applications. If a Form 471 fails to
meet these requirements, the Form 471 will be rejected. The SLD may be
prevented from returning the rejected Form 471 to the sender if the form
lacks essential identifying information. If an applicant receives a
returned Form 471, it is important that it resubmit the corrected form
quickly. Once the corrected form is successfully processed, the postmark
date of that corrected form will be the postmark date for the purpose of
the application filing window deadline.

**Manual Filers**

**1. Correct Form:** Each Form 471 must be:

a.  the correct, OMB-approved FCC Form 471, with a date of October 2002
    or October 2000 in the lower right-hand corner;

b.  submitted by regular mail, express delivery, or U.S. Postal Service
    Return Receipt Requested, or hand delivery. Forms may not be
    submitted by fax or e-mail. You are advised to keep proof of the
    date of mailing.

**2. Billed Entity Information:** In Block 1, each of the following
items must be properly completed. The "Billed Entity" is the entity
actually paying the bills for the services listed on the Form 471.

a.  Item 1 or Item 3 -- Either the Name of the Billed Entity or the
    Entity Number;

b.  Item 2 -- Funding Year;

c.  Item 6a -- Contact Person Name

If any of these items is blank, and the information cannot be obtained
from the page headers, the Form 471 will be rejected.

**3. Complete Submission of Form 471:** All 6 blocks of the Form 471
must be submitted. If any Block (1-6) of the paper form is missing, the
form will be rejected. Please note that Block 2, which indicates that
this Form 471 is being filed to make a minor modification to a
previously filed Form 471, will usually be left blank.

**4.** **Block 4 Worksheet:** At least one completed Block 4 Worksheet
relevant to your application type (see Block 1, Item 5) must be
submitted. If a relevant Block 4 Worksheet is not submitted, or the
Worksheet is missing information, the form will be rejected.

-   If the application type is school or school district, a completed
    Block 4 Worksheet A must be submitted.

-   If the application type is library, a completed Block 4 Worksheet B
    must be submitted.

-   If the application type is consortium, a completed Block 4 Worksheet
    C must be submitted.

**5. Complete Submission of Each Block 5 Funding Request:** Each Block 5
Funding Request must meet the following requirements in order to be data
entered as part of the Form 471. If any of the requirements is missing,
the Funding Request will be automatically deleted from the form. If all
of the Block 5 Funding Requests fail to meet these requirements, the
form will be rejected.

Each Block 5 Funding Request must, at a minimum, include:

a.  Item 11 -- Category of Service;

b.  Item 13 or Item 14 -- Either the Service Provider Identification
    Number or the Service Provider Name;

c.  Item 23 -- At least one entry with a positive dollar value in Column
    E, H, I, or K must be completed. Please note that you may not
    increase your request after filing your Form 471, unless you submit
    a new Form 471. Therefore, you should take care to complete **ALL**
    applicable columns of Item 23.

In addition to the requirements listed above for Block 5, if certain
components reflect a violation of program rules, they will invalidate
the Funding Request featured for that service item. Discounts on
services reflected in such Funding Requests will not even be entered
into the SLD system; such a Funding Request will be automatically
rejected, even while other Block 5 Funding Requests may be honored.

6.  **Valid Certification:** Block 6, Item 34 -- Signature of authorized
    person must be completed. If Item 34 is left blank, the Form 471
    will be rejected.

Online Filers:

When Blocks 1-5 of a Form 471 are submitted online, the applicant must
also (1) submit the completed Block 6 certification online with a User
ID and a PIN or (2) submit the completed and signed paper Block 6
certification by mail, express delivery or U.S. Postal Service Return
Receipt Requested. Online submission of Blocks 1-5 is complete after you
click on the "SUBMIT" button. If the Block 6 certification is submitted
on paper, you are advised to keep proof of the date of mailing. The
Block 6 certification is reviewed to make sure it complies with the
requirement in #6 above. Reviewers also look for the Form 471
Application Number before the Certification and Signature Page is
accepted and the Form 471 reaches "certified" status. If the paper Block
6 certification document lacks the information necessary to match it
with the Blocks 1-5 of the form you filed online, then your application
will not meet the application window filing requirements.

Filing Requirements for Forms 471 Submitted on Paper and Online:

**1. Application Materials:** The following materials associated with
Funding Year 2003 Form 471 must be received by 11:59 p.m. EST on January
16, 2003 or postmarked on or before January 16, 2003 in order for the
request to receive consideration as inside the window. These materials
are:

-   The Form 471 itself (whether online or on paper)

-   The Block 6 certification of the Form 471 with the signature of the
    authorized person (whether online or on paper)

-   The Block 5 certification of any Form 470 cited in a Funding Year
    2003 Form 471 with the signature of the authorized person (whether
    online or on paper). Forms 470 with completed certifications
    submitted in a previous year meet this requirement. Any Funding Year
    2003 Form 471 Block 5 funding request based on a Form 470 whose
    certification has not been received by 11:59 p.m. EST on January 16,
    2003 or postmarked on or before January 16, 2003 will be rejected.

2\. Item 21 Attachment Labeling: Label your attachment as "Item 21
Attachment," and include the application number of the Form 471 it
supports, or use the Applicant Form Identifier if you file on paper. Be
sure to label the attachment to correspond with each Block 5, Item 21 of
your application.

January 16, 2003 Deadline: Failure to make the January 16, 2003 deadline
for Form 471 application materials will place the entire application
outside the window, and the applicant's funding will be jeopardized.

**IV. SPECIFIC INSTRUCTIONS**

You are encouraged to complete and submit this form online. It will be
available on the SLD web site at www.sl.universalservice.org when the
Form 471 application filing window opens along with instructions for
filing online using the web site. Alternatively, for paper submissions,
you may download a paper version of the form from the SLD web site at
www.sl.universalservice.org. If you file paper copies of the
application, please type or clearly print in the spaces provided and
attach additional pages if necessary and when required.

A.  **Top of Form**

The data at the top of Form 471 will help both you and the SLD identify
each particular Form 471 you file.

**"Do Not Write In This Area"** - The SLD uses this space to apply a bar
code to your form upon receipt, so that we can properly track and
archive your form.

**Applicant's Form Identifier** (11 characters maximum) **-** If you are
filing more than one Form 471, please use this space to assign a unique
number or letter of your own devising to facilitate communication with
us about THIS particular Form 471. This Applicant's Form Identifier can
be very simple; for example, if you are filing three Forms 471, you
might label them "A," "B," and "C." The Applicant's Form Identifier can
also be descriptive, such as "Internet." Choose identifiers that suit
your own record keeping needs.

**Form 471 Application Number** - The SLD will assign and insert your
Form 471 Application Number. Leave this item blank.

**Top of each page after page 1:** If you are filing this application on
paper, please provide the Entity Number (from Item 3, below), your
Applicant's Form Identifier, and name and phone number of the contact
person (from Item 6, below) at the top of each page of the application
in the space provided. This will help alleviate problems caused if the
pages of an application become separated.

**B. Block 1: Billed Entity Information**

Block 1 of Form 471 asks you for your address and basic identifications.
"You" refers throughout this form to the billed entity -- the party
actually paying bills for the eligible schools and libraries listed in
this application form.

**Item 1** (30 characters maximum) - Provide the name of the billed
entity. As the billed entity, you may be an individual school, a school
district that is the billed entity for its schools, a library
(outlet/branch, system), or a consortium of those entities. You may also
be a city, a state, or an entity created solely to participate in this
universal service discount mechanism, but only if you are the billed
entity, in that you actually pay the bills for the service to the
service provider. **The billed entity itself may or may not be eligible
for discounts.**

**Item 2** - Funding years begin on July 1 and end on June 30 each year.
For example, Funding Year 2003 runs from July 1, 2003 to June 30, 2004.
Provide the funding year for which you are applying for funds by filling
in the appropriate year in the blanks provided (e.g., July 1,
[2003]{.underline} through June 30, [2004]{.underline}).

**Item 3** - Your Entity Number is a unique number assigned to your
organization or institution by the SLD as a means of identifying you
every time you file an application or otherwise communicate with us. If
you have applied for universal service funds in previous years, or have
been identified in an application filed on your behalf, you have already
been assigned an Entity Number. If you do not have a record of your
Entity Number, or if you have never been assigned such a number, please
call the SLD Client Service Bureau at 1-888-203-8100.

**Items 4a-4d** - Provide your full mailing address, whether a street
address, Post Office Box number, or route number. You are strongly
encouraged to provide a street address rather than a Post Office Box if
possible, as the Fund Administrator may need to contact you via
overnight or express delivery. In addition, please provide your
telephone number with area code and extension, fax number, and e-mail
address if you have one (33 characters maximum).

**Item 5** - Check the one box that best describes the type of
application you are filing. If you are filing as a school, you should
check the first box. If you are filing as a school district, you should
check the second box. If you are filing as a library (outlet/branch,
system), you should check the third box. If you are filing as a
consortium, you should check the fourth box. (You may be a consortium of
schools, libraries, or some combination of the above which may or may
not include ineligible entities. If you are filing as a library
consortium, you should check the fourth box.)

In addition, if you are a consortium that includes non-governmental
entities ineligible for universal service support, please check the box
provided to indicate this. Non-profit 501(c)(3) organizations are NOT
governmental entities. (Note: Consortium members eligible for universal
service support such as "rural health care providers" should be treated
as "governmental entities" for the purpose of these categories.) If your
consortium includes ineligible non-governmental entities, you should
note that you cannot negotiate pre-discount prices below tariff rates
for interstate services from incumbent local telephone companies.

**Item 6a** (30 characters maximum) - Provide the name of the person who
should be contacted with questions about this application. This person
should be able to answer questions regarding the information included on
this form and the services you request.

**Items 6b-6f** - If the contact person's address, phone number, fax
number, or e-mail address is different from those specified for the
applicant in Item 4, please provide that information here. You MUST then
check your preferred mode of contact. Wherever possible, the SLD will
use this mode to contact you. In addition, in Item 6f, you may choose to
provide an alternate telephone number, address, contact name, or special
operating hours that we may use to reach you during
holiday/vacation/summer periods (50 characters maximum).

**C. Block 2: Minor Modification to Existing Contract or Service
Agreement**

**Item 7** - Before completing this item, please check for guidelines at
the SLD web site at www.sl.universalservice.org or by calling the SLD
Client Service Bureau at 1-888-203-8100. The occasions for required use
of this item will be identified each funding year. This item may be
filed ONLY on paper. No online filings will be accepted for this item.
**In general, you will leave this item blank.**

**D. Block 3: Impact of Services Ordered in This Application**

Block 3 asks for data to help the Fund Administrator document the
potential impact of the universal service program for schools and
libraries across the country, and compare that impact from year to year.
Block 3 requests data pertinent to THIS application only. If you file
multiple applications, you may provide different data in this section in
each application. You need complete only those items that are relevant
to your application. Please use precise data wherever possible, and your
best estimates wherever necessary.

**Items 8a-8b -** Quantify the number of people affected by the services
ordered in this application. Schools/school districts should complete
Item 8a, libraries should complete Item 8b, and consortia should
complete either or both as appropriate.

**Item 8a** - If your application includes eligible K-12 schools,
provide the total number of students that will potentially be affected
by the services ordered in this application.

**Item 8b** - If your application includes eligible libraries, provide
the approximate number of patrons potentially affected by the services
ordered in this application, as defined by the number of cardholders you
serve or other estimates of regular library users.

**Items 9a-9k -** These questions ask you to quantify the expected
outcomes of the services you are ordering with this application. The
questions focus on typical benchmarks of technology development for
schools and libraries, and request data about these benchmarks before
and after your order as reflected in this Form 471. Some are more
relevant to certain types of applicants than others. **Please answer ALL
the questions that are relevant to your situation and THIS
application.** If the quantity or capacity of a service you order
remains the same before and after your order, please complete that
question by entering the same data in both columns.

**Item 9a** - If you are ordering telephone service to reach classrooms,
please indicate how many classrooms had telephone service before and
after your order.

**Items 9b and 9c** - If your order includes high-bandwidth
voice/data/video service provided by a telecommunications provider,
please indicate in Item 9b how many buildings had such service before
your order and how many will have such service after your order. In Item
9c, indicate the highest speed of such service to a building before and
after your order. If this service also provides your buildings with
Internet access, please be sure to quantify that access by completing
Item 9h and/or Item 9i.

**Items 9d and 9e** - If your order includes dial-up Internet access,
please identify in Item 9d the number of dial-up connections before and
after your order. In Item 9e, indicate the highest speed of such
connections before and after your order. If you complete this item,
please also complete Item 9h-9j as appropriate.

**Items 9f and 9g -** If your order includes direct access to the
Internet via lines identified in this application for Internet access
only, please indicate in Item 9f the number of such connections before
and after your order. In Item 9g, indicate the highest speed of such
connections before and after your order. If you complete this item,
please also complete Items 9h-9j as appropriate.

**Item 9h -** If your application includes schools and provides for
Internet access either directly or indirectly, please provide your best
estimate of the number of rooms with Internet access before and after
your order. Please also complete Item 9j.

**Item 9i** - If your application includes libraries and provides for
Internet access either directly or indirectly, please provide your best
estimate of the number of buildings (including bookmobiles) with
Internet access before and after your order. Please also complete Item
9j.

**Item 9j** - Provide your best estimate of the number of computers or
other devices (such as television sets, hand-held units, network
terminals, and other non-PC Internet appliances) that had Internet
access before your order, and how many will have Internet access after
your order. These devices may access the Internet directly or via a
local area network. If you complete this item, be sure to also reflect
the quality and capacity of that access by completing Items 9b and 9c,
and/or Items 9d and 9e, and/or Items 9f and 9g.

**Item 9k -** Use this item to describe any other relevant outcome of
your order not captured in the items above. We are particularly
interested in new and emerging technology solutions made possible by
eligible services ordered in this application.

# **E. Block 4: Discount Calculation Worksheets** {#e.-block-4-discount-calculation-worksheets .unnumbered}

This block consists of three separate worksheets designed to meet the
needs of those filing as:

-   Schools/school districts -- Worksheet A (see step-by-step
    instructions).

-   Libraries (outlet/branch, system) -- Worksheet B (see step-by-step
    instructions).

-   Consortia -- Worksheet C (see step-by-step instructions).

Each worksheet includes its own instructions and its own step-by-step
discount calculation chart. NOTE: If you are filing as a consortium, you
may also need to include one or more Worksheets A and/or one or more
Worksheets B (see step-by-step instructions for Worksheet C).

**[Instructions for Each Worksheet]{.underline}**

**Worksheet A: Discount Calculation for those entities filing as
Schools/School Districts**

If you checked the first or second box in Block 1, Item 5, you should
use this worksheet.

**Item 10a -** If you are filing this application as:

-   a school, you need only complete one line of Item 10b, Columns 1-7.
    All of the services for which you are applying will be subject to
    the same site-specific discount you calculate here.

-   a school district serving more than one school, and you are
    requesting services that will go ONLY to individual schools and will
    not be shared, complete Columns 1-7 of Item 10b for each school.

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-   a school district, and ALL of the schools in your district will
    share one or more services (whether or not those schools will also
    receive site-specific services), complete Columns 1-8 for each of
    your schools PLUS Item 10c.

-   a school district and if some services you are requesting will be
    shared by some schools and not others (whether or not those schools
    will also receive site-specific services), complete a separate
    worksheet, Columns 1-8 PLUS Item 10c, for each different group of
    schools sharing a service. You will then label the worksheets A-1,
    A-2, A-3, etc.

**Item 10b -** Use this worksheet as instructed in Item 10a to calculate
the appropriate discount(s).

**Item 10b, Column 1:** For each school included in your application,
list the school by name on a separate row. For a new school under
construction, label this item "New School Construction" followed by the
name of the school, in parentheses, if it is known at the time the Form
471 is submitted. If your district office or other administrative
building(s) in your district is eligible for services, label this item
"Administrative Entity" followed by the name, in parentheses, of the
district office or other administrative building.

**Item 10b, Column 2:** List each school's Entity Number. If you do not
know the Entity Number for a particular school or administrative
building, call the Client Service Bureau at 1-888-203-8100.

**Item 10b, Column 3:** Indicate whether each school is located in an
urban or a rural area. You should base your assessment on the table
posted in the "Rural/Urban Classification" information on the SLD web
site at www.sl.universalservice.org. Instructions accompanying the table
will help you determine whether the school is located in an urban or a
rural area for purposes of the universal service support mechanism.

***Calculating Each School's Site-Specific Discount (Columns 4-7)***

**Item 10b, Column 4:** List the total number of K-12 students in each
school. For "New School Construction" or for an "Administrative Entity,"
enter "0" in this item.

**Item 10b, Column 5:** Provide the number of students eligible for the
National School Lunch Program (NSLP) as of the October 1st prior to the
filing of this form, or use the most current figure available. For "New
School Construction" or for an "Administrative Entity," enter "0" in
this item. You may choose to use an actual count of students eligible
for the National School Lunch Program or use federally approved
alternative mechanisms to determine the level of poverty for purposes of
the universal service discount program. Schools using a federally
approved alternative mechanism may use participation in other
income-assistance programs, such as Medicaid, food stamps, Supplementary
Security Income (SSI), federal public housing assistance (Section 8), or
Low Income Home Energy Assistance Program (LIHEAP) to determine the
number of students that would be eligible for the NSLP. See 34 C.F.R. §
200.28(a)(2)(i)(B). For more information, please refer to the
"Alternative Discount Mechanisms Fact Sheet" posted on the SLD web site
at www.sl.universalservice.org.

**Item 10b, Column 6:** For each school, divide Column 5 by Column 4 to
arrive at the percentage of students eligible for the National School
Lunch Program. Discount calculations may be rounded up only when fully
half a discount point is reached. For example, an urban school with a
discount eligibility of 34.499% will round down to 34%, and an urban
school with a discount eligibility of 34.500% will round up to 35%. For
eligibility discounts of less than 1%, however, there is no rounding.
For "New School Construction" or for an "Administrative Entity," leave
this item blank.

**Item 10b, Column 7:** Using the percentage in Column 6 and the
Discount Matrix (see below), you should determine the percentage
discount to which the school is entitled. If you file online, the system
will calculate this figure for you. If you have any questions about
determining this figure, you can call the SLD Client Service Bureau for
assistance at **1-888-203-8100**. For "New School Construction" or for
an "Administrative Entity" ONLY, enter the Weighted Average Discount for
the School District. (A preparatory Worksheet A must be submitted
documenting the Weighted Average Discount for the School District or, if
a Worksheet A already includes all schools in the School District, label
that worksheet "All Schools in the School District.")

DISCOUNT MATRIX

+---------------------------+--------------------+--------------------+
| **INCOME**                | **URBAN LOCATION** | **RURAL LOCATION** |
|                           |                    |                    |
| **Measured by % of        | **Discount**       | **Discount**       |
| students eligible for the |                    |                    |
| National School Lunch     |                    |                    |
| Program**                 |                    |                    |
+---------------------------+--------------------+--------------------+
| If the percentage of      | ...and you are in  | ...and you are in  |
| students in your school   | an URBAN area,     | a RURAL            |
| that qualifies for the\   | your\              |                    |
| National School Lunch     | discount will      | area, your\        |
| Program is...             | be...              | discount will      |
|                           |                    | be...              |
+---------------------------+--------------------+--------------------+
| Less than 1%              | 20%                | 25%                |
+---------------------------+--------------------+--------------------+
| 1% to 19%                 | 40%                | 50%                |
+---------------------------+--------------------+--------------------+
| 20% to 34%                | 50%                | 60%                |
+---------------------------+--------------------+--------------------+
| 35% to 49%                | 60%                | 70%                |
+---------------------------+--------------------+--------------------+
| 50% to 74%                | 80%                | 80%                |
+---------------------------+--------------------+--------------------+
| 75% to 100%               | 90%                | 90%                |
+---------------------------+--------------------+--------------------+

***Calculating a Shared Discount for the School District (Column 8 and
Item 10c)***

**Item 10b, Column 8:** For each school receiving an appropriate share
of shared services, multiply the discount rate for the school (Column 7)
by the number of students in the school (Column 4). If you file online,
the system will calculate this figure for you. The product is the
school's weighted discount. For "New School Construction" or for an
"Administrative Entity," leave this item blank.

**Item 10b, Column 4, last cell:** Add all of the students in all of the
schools listed, and enter the total into the last cell at the bottom of
Column 4. If you file online, the system will calculate this figure for
you.

**Item 10b, Column 8, last cell:** Add together all of the products in
Column 8, and enter the total into the last cell at the bottom of Column
8. If you file online, the system will calculate this figure for you.

**Item 10c -** Divide the total at the bottom of Column 8 by the total
at the bottom of Column 4. Round the result to the nearest whole number
percentage, and enter it into Item 10c. If you file online, the system
will calculate this figure for you.

**Worksheet B: Discount Calculation for those entities filing as
Libraries**

If you checked the third box in Block 1, Item 5, you should use this
worksheet.

**Item 10a -** If you are filing this application as:

-   a library consisting only of one outlet/branch, you need only
    complete one line of Item 10b, Columns 1-4. All of the services for
    which you are applying will be subject to the same site-specific
    discount you calculate here.

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-   a library and you are a library system with more than one
    outlet/branch, and you are requesting services that will go ONLY to
    individual outlets and will not be shared, complete Columns 1-4 of
    Item 10b for each outlet.

-   a library and you are a library system with multiple
    outlets/branches, and ALL of the outlets/branches will share one or
    more services (whether or not those outlets/branches will also
    receive site-specific services), complete Columns 1-4 PLUS Item 10c.

-   a library and you are a library system with some of the services you
    are requesting shared by some outlets/branches and not others
    (whether or not those outlets/branches will also receive
    site-specific services), complete a separate worksheet, Columns 1-4
    PLUS Item 10c, for each different group of outlets/branches sharing
    a service. You will then label the worksheets B-1, B-2, B-3, etc.

**Item 10b -** You will use this worksheet as instructed in Item 10a to
calculate the appropriate discount(s).

**Item 10b, Column 1:** For each library outlet/branch included in your
application, list the outlet/branch by name on a separate row. For a new
library under construction, label this item "New Library Construction"
followed by the name of the library, in parentheses, if it is known at
the time the Form 471 is submitted. If your library system office or
other administrative building(s) is eligible for services, label this
item "Administrative Entity" followed by the name, in parentheses, of
the library system or other administrative building.

**Item 10b, Column 2:** List the Entity Number for each library
outlet/branch. If you do not know the Entity Number for a particular
library outlet/branch or administrative building, call the SLD Client
Service Bureau at 1-888-203-8100.

***Identifying the Site-Specific Discount for Each Library Outlet***

**Item 10b, Column 3:** List the name of the public school district in
which each library outlet/branch is located.

**Item 10b, Column 4:** The level of poverty for a library outlet/branch
is based on the percentage of student enrollment that is eligible for a
free or reduced price lunch under the National School Lunch Program or a
federally approved alternative mechanism in the public school district
in which the library is located. If you are using the percentage of
students eligible for the National School Lunch Program, you may
generally obtain the necessary information by contacting your local
school district.

To determine the discount to which the library is entitled under E-rate,
you must perform a two-step procedure. First, calculate the percentage
of the students eligible for the National School Lunch Program in the
school district in which the library is located. Second, use the
Discount Matrix (see above) to determine the discount to which the
library is entitled under E-rate. This discount must be entered in Item
10b, Column 4.

FIRST STEP: To calculate the percentage of students eligible for the
National School Lunch Program, take the **number of students eligible**
for the National School Lunch Program (NSLP**) in the school district in
which the library outlet/branch is located (listed in Column 3) and
divide by the total number of students in that school district**. Use
the number of students eligible for the National School Lunch Program
(NSLP) as of the October 1^st^ prior to the filing of this form or use
the most current figure available. Discount calculations may be rounded
up only when fully half a discount point is reached. For example, a
library outlet/branch with a calculated NSLP percentage of 34.499% will
round down to 34%, and a library outlet/branch with a calculated NSLP
percentage of 34.500% will round up to 35%. For calculated NSLP
percentages of less than 1%, there is no rounding.

You may choose to use a federally approved alternative mechanism for the
public school district in which the library is located to determine the
level of poverty for purposes of the universal service discount program.
Those using a federally approved alternative mechanism may use
participation in other income-assistance programs, such as Medicaid,
food stamps, Supplementary Security Income (SSI), federal public housing
assistance (Section 8), or Low Income Home Energy Assistance Program
(LIHEAP) to determine the number of students that would be eligible for
the NSLP. See 34 C.F.R. § 200.28(a)(2)(i)(B). For more information,
please refer to the "Alternative Discount Mechanisms Fact Sheet" posted
on the SLD web site at www.sl.universalservice.org.

SECOND STEP: **Using the percentage calculated for the school district
and the Discount Matrix (see above),** **determine the discount to which
the library is entitled under E-rate.** (NOTE: You must determine if the
library outlet/branch is located in an urban or rural area based on the
table posted in the "Rural/Urban Classification" information on the SLD
web site at www.sl.universalservice.org. Instructions accompanying the
table will help you determine whether the library outlet/branch is
located in an urban or a rural area for purposes of the universal
service support mechanism.) For example, a library outlet/branch which
is located in an urban area with a calculated NSLP eligibility of 34% is
eligible for a 50% E-rate discount from the Discount Matrix, and a
library outlet/branch which is located in an urban area with a
calculated NSLP percentage of 35% is eligible for a 60% E-rate discount
from the Discount Matrix. For calculated NSLP percentages of less than
1%, there is no rounding, and the E-rate discount from the Discount
Matrix is 20% for urban and 25% for rural.

For "New Library Construction," enter the discount from the Discount
Matrix calculated as described above for the school district in which
the library under construction is located. For an "Administrative
Entity," enter the Library System's Average Discount from Item 10c after
it is calculated.

***Calculating the Shared Discount for the Library System***

**Item 10b, Column 4, last cell:** Add up all of the discounts in this
column and enter the total in the cell at the bottom of Column 4. If you
file online, the system will calculate this figure for you.

**Item 10c -** Divide the total at the bottom of Column 4 by the total
number of library outlets/branches listed in Column 1. Round the result
to the nearest whole number percentage, and list this number in Item
10c. This is the library system's shared discount. If you file online,
the system will calculate this figure for you.

**Worksheet C: Discount Calculation for Consortia**

If you checked the fourth box in Block 1, Item 5, you should use this
worksheet. This worksheet should be used for a consortium of schools,
school districts, libraries (outlets/branches, systems) or any
combination of the above.

**Item 10a -** If you are filing this application as:

-   a consortium and you are requesting services that will go ONLY to an
    individual consortium member and will not be shared, complete
    Columns 1-3 of Item 10b for each member.

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-   a consortium and if ALL consortium members will share one or more
    services (whether or not those consortium members will also receive
    site-specific services), complete Columns 1-3 for each member of
    your consortium PLUS Item 10c.

-   a consortium, and some requested services will be shared by some
    consortium members and not others (whether or not those consortium
    members will also receive site-specific services), you must complete
    a separate worksheet, Columns 1-3 PLUS Item 10c, for each different
    group of consortium members sharing a service. You will then label
    the worksheets C-1, C-2, C-3, etc.

**Item 10b -** You will use this worksheet as instructed in Item 10a to
calculate the appropriate discount(s).

**Item 10b, Column 1:** For each eligible consortium member included in
your application, list the member by name on a separate row. Do not list
ineligible consortium members, as they will not receive discounted
services.

**Item 10b, Column 2:** List each eligible consortium member's Entity
Number. If you do not know the Entity Number for a particular eligible
consortium member, call the SLD Client Service Bureau at 1-888-203-8100.

***Identifying the Site-Specific Discount for Each Member***

**Item 10b, Column 3:** Provide the correct discount for each eligible
member depending on the type of entity it is.

-   If the member is an individual school, use the discount from
    Worksheet A, Column 7. Attach a completed Worksheet A showing the
    calculations for each school that is a member of your consortium.

-   If the member is a school district, use the discount from Worksheet
    A, Item 10c (the weighted average discount). Attach a completed
    Worksheet A showing the calculations for each school district that
    is a member of your consortium.

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-   If the member is a library outlet/branch, use the discount
    calculated as explained above for Worksheet B, Column 4.

-   If the member is a library system, use Worksheet B, Columns 1-4 PLUS
    Item 10c, to calculate the discount. Attach a complete Worksheet B
    showing these calculations for each library system that is a member
    of your consortium.

***Calculating the Shared Discount for the Consortium***

**Item 10b, Column 3, last cell:** Add up all of the discounts in this
column and enter the total in the cell at the bottom of this column. If
you file online, the system will calculate this figure for you.

**Item 10c -** Divide the total at the bottom of Column 3 by the total
number of consortium members listed in Column 1. Round the result to the
nearest whole number percentage, and list this number in Item 10c. This
is the shared discount for the entire consortium. If you file online,
the system will calculate this figure for you.

**F. Block 5: Services Ordered**

Block 5 asks you to provide information about the eligible services that
you have ordered, their cost, and the discount you are requesting based
on the entities to receive service. The following information will
highlight the features of Block 5:

You will complete one Block 5 worksheet for **each** Funding Request. In
general, you should

complete a separate Funding Request page for:

-   Each service provider that will be providing you with service.

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-   Each separate contract or service agreement (but not necessarily the
    individual service within that contract or agreement, as long as
    they are in the same category of service, e.g. telecommunications
    services).

-   Each different category of service provided by the same provider.
    For example, a PBX system that the applicant will purchase and own
    and local voice service from the same telephone company should go on
    separate Block 5 worksheets, since the PBX would be Internal
    Connections and the phone service is Telecommunications Services.
    Check the "Eligible Services List" and any updates at
    www.sl.universalservice.org to identify which category each service
    belongs in.

-   Local phone service.

-   Long distance phone service.

-   Site-specific service (service not shared by other sites).

-   If you are ordering services based on different Forms 470, services
    corresponding to each Form 470 must be reported on separate Block 5
    worksheets with the relevant Form 470 Application Numbers.

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-   **Priority 1 and Priority 2 services.** Applicants who are applying
    for both Priority 1 (Telecommunications Services or Internet Access)
    and Priority 2 (Internal Connections) services are strongly
    encouraged to file these requests on separate Forms 471 --- that is,
    to file one or more Forms 471 for their Priority 1 requests and one
    or more Forms 471 for their Priority 2 requests.

-   **Ineligible costs:** You may not seek support for ineligible
    services, entities, and uses. The Block 5 worksheet will guide you
    through deducting any ineligible costs from your total cost of
    services before calculating your discount request. If you have any
    questions about whether a service is eligible for support, please
    check the "Eligible Services List" on the SLD web site at
    www.sl.universalservice.org or contact the SLD Client Service Bureau
    at 1-888-203-8100.

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-   **Signed contracts:** You MUST have a signed contract (or a legally
    binding agreement

> between you and your service provider preparatory to a formal signed
> contract) for all services you order on your Form 471 except:

1.  *Tariffed services:* Telecommunications services that you purchase
    at prices regulated by your state regulatory commission and/or the
    FCC, which do not require a signed, written contract.

-   *Month-to-Month Services:* Month-to-Month services which do not
    require a signed, written contract. Your billing arrangement
    signifies that you are receiving your services on a month-to-month
    basis.

Note: You must file a Form 470 and seek competitive bids for tariffed or
month-to-month services each funding year.

-   **Eligible service providers:** To provide you with
    telecommunications services, Internet access and internal
    connections under this program, a service provider must secure a
    Service Provider Identification Number (SPIN) from the Universal
    Service Administrative Company and certify that they will comply
    with program rules. ***However, telecommunications services may be
    obtained only from telecommunications companies who provide those
    telecommunication services on a common carriage basis (meaning they
    provide their services for a fee to the general public).*** You may
    check the "BEAR/SPIN Search" on the SLD web site at
    www.sl.universalservice.org to confirm whether your service provider
    is eligible to provide telecommunications services. If you receive
    telecommunications services from a provider that does not provide
    telecommunications services on a common carriage basis, your Funding
    Request for such services will be denied.

1.  **Discounted and undiscounted amounts:** Form 471 requires you to
    certify in Block 6, Item 25 that you have adequate budgetary
    resources for the undiscounted portion of any service you seek, as
    well as for related, ineligible services such as computers,
    training, software, maintenance, and electrical connections that you
    will need to make effective use of the services you order.

**[Item-by-Item Instructions]{.underline}**

**FRN \#** - The Fund Administrator will assign a unique number to each
Funding Request represented on a Block 5 worksheet.

**Item 11 -** Check the correct category for the service listed on this
Block 5 Funding Request. You may check only ONE. Please consult the
"Eligible Services List" and any updates on the SLD web site at
www.sl.universalservice.org or contact the SLD Client Service Bureau at
1-888-203-8100.

**Item 12 -** Provide the 15-digit FCC Form 470 Application Number of
the FCC Form 470 in which the services ordered here were sought. FCC
Form 470 applicants will receive this number when they receive
confirmation that their FCC Form 470 has been received and posted.

**Item 13 -** Enter the 9-digit Service Provider Identification Number
(SPIN) for this service provider. You must provide a valid SPIN for the
service provider indicated in Item 14 below. Each service provider
should give you its SPIN on request. You may refer to the "BEAR/SPIN
Search" area of the SLD web site for a list of service provider
contacts. A service provider who does not have a SPIN should file the
FCC Form 498 to obtain one. The Form 498 and Instructions can be
downloaded from the Forms Area of the SLD web site.

**Item 14** (30 characters maximum) - Provide the full legal name of the
service provider for this Funding Request. You may list only ONE service
provider per Block 5 worksheet. The name of your Service Provider whose
SPIN is indicated in Item 13 above must be provided.

**Item 15** (18 characters maximum) - Provide the contract number for
this service.

-   If this is a contracted service, and the contract does not have a
    contract number but has some other reference number, you should note
    that number. If there is no reference number, please enter N/A.

-   If you are buying off of a master contract signed by a state,
    regional or local procurement agency on behalf of eligible schools
    and libraries, you may use either the master contract number or the
    number of your own purchase agreement executed pursuant to that
    master contract. Whichever number you use, be certain that you use
    the corresponding dates in Item 18 and Item 20.

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-   If this is a tariffed service--- a telecommunications service that
    you purchase at prices (rates) regulated by your state regulatory
    commission and/or the FCC which does not require a signed, written
    contract---place a T in Item 15.

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-   Certain services are commonly offered on the basis of a
    month-to-month arrangement where there may be no written agreement
    between the customer and the service provider. These include
    services such as Internet access, cellular services and paging
    services. In these instances, standard monthly bills will be
    accepted as proof of a binding, legal arrangement between the
    service provider and the customer. (These arrangements are different
    from tariffed services, which may also be offered month-to-month but
    at regulated prices.) If the service for which you are completing
    Block 5 is purchased under such a month-to-month arrangement, please
    enter MTM (for "month-to-month") in Item 15.

**Item 16** (18 characters maximum) **-** Provide the account number
that your service provider has established with you for billing
purposes. This information will help your service provider provide you
with discounted bills for service. In the case of telephone services,
this is most often the billed telephone number associated with the
service. **If there are multiple billed telephone numbers, provide one
main number**. If this service is already established (for example, a
service provided under a qualified existing contract, or tariffed
services for which you have selected the same service provider who
already provides you with service), you should be able to find your
account number on past bills, or you can request your account number
from the service provider. If you have not yet established an account
number, your service provider may have a "pre-account" identifier for
you to use. If your service provider has no account number to identify
your service, enter N/A.

**Item 17 -** List the Allowable Vendor Selection/Contract Date for this
service. The Allowable Vendor Selection/Contract Date is the earliest
date you are permitted to sign a contract for newly contracted services
or to select your service provider for tariffed or month-to-month
services after posting a Form 470. This Allowable Vendor
Selection/Contract Date is identified in your Receipt Notification
Letter for the Form 470 cited in Item 12 above, as well as on that
posted Form 470 on the SLD web site.

**Item 18 -** For contracted services, enter the date that your contract
for this service was signed, using mm/dd/yyyy format. For tariffed
services and month-to-month services that you have identified as such in
Item 15, leave this item blank.

**Item 19a -** For contracted, tariffed, and month-to-month services,
provide the date **when services will start in the funding year** for
which you are applying, using mm/dd/yyyy format. Note that discounts
will NOT be provided for services delivered before the beginning of the
funding year, which starts on July 1. Thus, if this service has already
started by the time you file this Form 471, you will use July 1 of the
funding year as your Service Start Date.

**Item 19b -** For tariffed and month-to-month services, enter the date
that services will end in the funding year for which you are applying,
using mm/dd/yyyy format. For contracted services, see Item 20 below.

**Item 20 -** For contracted services, enter the date the contract
expires, in mm/dd/yyyy format. For tariffed services and month-to-month
services that you have identified as such in Item 15, leave this item
blank.

**Item 21** (8 characters maximum) - Each Block 5 Discount Funding
Request must include a description of the products and services for
which discounts are being sought. This description is known as an "Item
21 Attachment." Each description must be labeled with a unique
"Attachment Number" that you create. For Item 21, please enter the
Attachment Number you have created.

You may cite the same description of services in multiple Block 5
Discount Funding Requests. For example, if you are ordering Internal
Connections products and services under a single contract for multiple
sites and the products and services are the same for each site, each
Block 5 Discount Funding Request may refer to a single Item 21
Attachment.

In general, the Item 21 Attachment is a narrative description of the
funding request and a line-item listing of the products and/or services
requested with their associated costs. Service providers can assist
applicants in the preparation of the Item 21 Attachment, which also must
include:

-   The applicant's name

-   The Attachment Number (see above)

-   The applicant's Billed Entity Number, and

-   The Form 471 application number, if one has been assigned through
    online filing.

The line-item listing of products and services may be submitted in a
table format as follows:

  ---------- ----------------------------- -------- ------------------- ---------------
  Quantity   Description of Product or     Unit     \-\-\-\--Extended   
             Service                       Cost     Cost\-\-\-\--       

                                                    Recurring           Non-Recurring

                                                                        

                                                                        

                                                                        
  ---------- ----------------------------- -------- ------------------- ---------------

In some circumstances, additional information may be required. For
example:

-   Ensure that any included ineligible products and/or services are
    identified and the cost of such products and/or services is
    deducted.

-   For maintenance services, include the specific list of components to
    be covered and break out the pricing for maintenance of these
    components.

-   For telephone services, indicate the number of phone lines and/or
    cell phones receiving service, and provide information about their
    use if any will be used for other than educational purposes.

-   A price quotation from the service provider, a representative bill
    for continuing services, or the criteria used to estimate new or
    increased costs, may be submitted if sufficient detail is provided
    in that documentation to determine the eligibility of the funding
    request.

-   If products or services are being purchased under a state master
    contract, include the contract number (if available) and the
    expiration date of the state master contract.

-   Include an explanation of the purpose, location, breakdown of
    up-front costs, or other information to provide a clear explanation
    of the funding request.

If questions arise during review of an application, the SLD may reach
out to the applicant to request additional information. For this reason,
applicants can significantly speed up the application review process by
including complete information in the Item 21Attachment.

**Item 22 -** Entities receiving this service. For site-specific
services that will be provided to one individual entity and not shared
by others (for example, a local area network to be installed in one
school building), provide the Entity Number of the individual entity
receiving that service in **Item 22a**. For shared services used jointly
by multiple entities (such as telecommunications services provided to
all of the outlets/branches in a library system), list the Block 4
Worksheet Number that shows the sharing entities and calculates the
shared discount for this service in **Item 22b**.

**Item 23** - Use the step-by-step calculation grid to arrive at the
total amount of your funding request. You may round dollar amounts to
the nearest dollar, but please use numerals and include all digits. **DO
NOT use words such as 1 million**, in place of 1,000,000. Note that if
you are seeking support on multi-year contracts, **you may request
funding only for that portion of the contract that is delivered in the
relevant funding year.**

Use Columns A-E for ***recurring*** charges (monthly charges) for this
service, and Columns F-H for ***non-recurring*** charges (one-time
charges) for this service.

You may request discounts only for products and services delivered in
the relevant funding year. Recurring services must be delivered between
July 1 and June 30 of the funding year. Non-recurring services must
generally be delivered between July 1 and the September 30 following the
close of the funding year. For more information, please refer to
"Service Delivery Deadlines and Extension Requests" on the SLD web site
at www.sl.universalservice.org.

**Item 23, Column A:** Estimate your total monthly cost for this
service. If the cost of service fluctuates from month to month, you may
use the average of past bills to estimate the monthly cost.

If you expect to pay a non-recurring charge in multiple installments
over the funding year, you should either amortize this charge in Columns
A-E or include the full amount of this charge in Columns F-H. **DO NOT**
include this amount under both recurring and non-recurring charges. If
you amortize this charge in Columns A-E, you will not be eligible for
discounts on the non-recurring services provided after June 30 of the
funding year.

**Item 23, Column B:** Enter the total cost associated with ANY
ineligible services, entities, or uses included in your monthly charges.
The following represent some common ways in which eligible and
ineligible costs are bundled together, and how you can go about
deducting the ineligible costs.

-   **Eligible services bundled with ineligible services:** While you
    may contract with the same service provider for both eligible and
    ineligible services, your contract or purchase agreement must
    clearly break out costs for eligible services from those for
    ineligible services. If the eligible and ineligible services were
    purchased together at a special "bundled" price, a proportionate
    cost allocation is required between the eligible and ineligible
    components. The applicant will use this reduced price when
    requesting universal service discounts on the eligible service. For
    example, if a provider offers to sell a school an eligible service
    for \$10.00 and an ineligible service for \$20.00, but also offers
    them as a bundle for \$24.00, this would indicate that the provider
    is offering a \$6.00, or 20%, price reduction. Therefore, the school
    could treat \$10.00 - 20% = \$8.00 as eligible for universal service
    support.

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-   **Services shared by eligible and ineligible entities:** When you
    share a service with an ineligible entity, the provider may receive
    reimbursement only for that portion of the service that eligible
    entities are receiving. To help auditors confirm that this rule is
    being observed, you must keep and retain careful records of how you
    have allocated the costs of shared services and facilities among
    eligible and ineligible entities. You should maintain these records
    consistent with any measures that may be established by the FCC, the
    SLD, or state commissions.

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-   **Bundled services from an Internet service provider:** You may
    receive discounts on access to the Internet but not on separate
    charges for particular proprietary content, other information
    services, or a package including content and conduit. The only
    exception is when the bundled package includes minimal content and
    provides a more cost-effective means of securing access to the
    Internet than other non-content alternatives. Thus, if a service
    provider bundles Internet access with a package of content that is
    available to all customers free of charge, the entire price of that
    bundle will be eligible for support. However, if the service
    provider a) does not offer an access-only service, and b) offers
    Internet users access to its proprietary content for a price, then
    you may treat the difference between the content-only price and the
    price it charges for its bundled access as the price of non-content
    Internet access.

**Item 23, Column C:** Subtract the amount in Column B from the amount
in Column A to arrive at your eligible monthly pre-discount cost.

**Item 23, Column D:** Provide the number of months you will be
receiving this service in the funding year.

**Item 23, Column E:** Multiply Column D by Column C to arrive at your
annual pre-discount cost for eligible recurring services.

**Item 23, Column F:** Estimate your total annual amount of
non-recurring (one time) pre-discount charges for this service.

**Item 23, Column G:** Provide the total cost here associated with any
ineligible service, entities, or uses included in your total annual cost
of service. See notes on Column B, above, for more information.

**Item 23, Column H:** Subtract the amount in Column G from the amount
in Column F to arrive at your total eligible pre-discount cost for
non-recurring services.

**Item 23, Column I:** Add together columns E and H to arrive at your
total eligible pre-discount costs (recurring and non-recurring) for the
year.

**Item 23, Column J:** Enter the correct discount for this service,
which is the discount you calculated for the entity or entities cited in
Item 22. Refer back to the appropriate Block 4 worksheet to assure that
you enter the correct discount.

**Item 23, Column K:** Multiply the amount in Column I by the discount
in Column J to arrive at your total funding commitment requested for
this service.

**G. Block 6: Certification and Signature**

Block 6 requires schools and libraries to certify certain information.
This information is required to ensure that only eligible entities
receive support under the universal service discount mechanism.

**"Do Not Write In This Area"** - The SLD uses this space to apply a bar
code to your form upon receipt, so that we can properly track and
archive your form.

**Special Block 6 Instructions for Applications Filed Online**

-   When you have completed the online filing of Blocks 1-5, please
    print your application to retain a copy for your records.

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-   You must also submit the Block 6 certification.

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-   If you have a User ID and PIN and wish to submit your Block 6
    certification online, follow the directions online. When you submit
    your certification online, you will receive a confirmation so that
    you can be assured that your submission has met any filing
    deadlines. If you file online and use online certification, do not
    mail any part of your Form 471 to the SLD, but do mail the Item 21
    attachments to the SLD as soon as possible after completing your
    Form 471. Make a copy of the online certification confirmation page
    and attach that to the top of the Item 21 attachment so that the SLD
    will be able to match the Item 21 attachment with the correct
    Form 471. Check the "PIN Request Area" of the SLD web site for
    information about obtaining a User ID and a PIN.

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-   If you wish to submit the completed and signed Block 6 certification
    on paper, print Block 6 using your browser. When you print Block 6
    using the browser, the form will automatically include your Form 471
    Application Number, Applicant Name, and Applicant Address. Item 34
    requires the signature of the authorized person who will certify to
    the accuracy of the information on the form. Also, you must complete
    Items 24-33. Mail the signed Block 6 to: **SLD-Form 471, P. O. Box
    7026, Lawrence, Kansas 66044-7026.** For express delivery services
    or U.S. Postal Service Return Receipt Requested, send to **SLD-Form
    471, c/o Ms. Smith, 3833 Greenway Drive, Lawrence, Kansas 66046**.
    Note: Do not mail the complete Form 471. Mail only the signed Block
    6 certification page along with your Item 21 Description of services
    and any other attachments. If the Block 6 certification is submitted
    on paper, you are advised to keep proof of the date of mailing.

    **For all applicants, filing on paper or online:**

    **Item 24** - Certify that the entities listed in Block 4 of your
    application are eligible schools and/or libraries. If your
    application includes schools and all of the information in **Item
    24a** is true of those schools seeking to receive discounted
    services, you should check the box in Item 24a. If your application
    includes schools and any of the information in Item 24a is not true
    for the schools seeking to receive discounted services, those
    schools are not eligible to receive support under the universal
    service discount mechanism, and you should not check this box.

    If your application includes libraries or library consortia and all
    of the information in **Item 24b** is true of the libraries seeking
    to receive discounted services, you should check the box in Item
    24b. If your application includes libraries or library consortia and
    any of the information is not true for the libraries or library
    consortia seeking to receive discounted services, those libraries or
    library consortia are not eligible to receive support under the
    universal service discount mechanism, and you should not check this
    box.

    **Item 25** - Certify that the current budget and any other budgets
    applicable to the current funding year for the eligible schools and
    libraries listed in Block 4 of this application will provide
    sufficient funding in this funding year to purchase all of the
    resources---including computers, training, software, maintenance,
    and electrical connections---that are necessary for you to make
    effective use of the eligible services you have requested in Block
    5, as well as to pay the non-discounted portion of the charges for
    eligible services.

    As part of our review of your Item 25 certification, the SLD may
    request additional documentation to support your certification. The
    certification in Item 32 below states that you will retain for five
    years any and all worksheets and other records that you rely upon to
    fill out your Form 471. For Item 25, these worksheets and records
    include:

-   **Paying your share of E-rate eligible costs.** You may be asked to
    provide documentation of your ability to pay the non-discounted
    portion of the products and services for which you have applied for
    discounts. You should already have the funds identified in your
    budget to pay for these costs. If your budget is not yet final, we
    may request additional documentation to substantiate your
    certification.

-   **Paying for ineligible costs.** You may be asked to provide
    estimates of hardware, software, professional development,
    retrofitting (construction and electrical work necessary to prepare
    a building for technology), maintenance investments and other
    resources that are necessary to make effective use of the E-rate
    discounts you have requested. These resources may or may not be
    eligible for E-rate discounts. Again, if these resources will be
    purchased under your budget, you should already have the funds
    identified in your budget to pay for them. However, these resources
    may also be ones that you already have or own, such as computers
    purchased or donated in a prior year.

-   **Technology Plan.** If you applied for more than basic local and
    long distance telephone services, you may be asked to provide a copy
    of your Technology Plan. Your Technology Plan should include a
    description of the products and services necessary to accomplish
    your technology service goals, whether they are eligible or
    ineligible for E-rate discounts.

-   **Status of technology before and after E-rate discounts.** You may
    be asked to provide an estimate of the level of technology for all
    recipients of discounted services included in your application. This
    estimate would describe the level of technology for each recipient
    both at the beginning of the funding year and after the planned
    products and services in your Technology Plan are delivered and
    installed.

    **Items 26 and 27** concern the technology plans that must be
    prepared and approved before schools and libraries may receive
    discounted services under the universal service support mechanism.
    The only schools and libraries that do not have to comply with the
    technology plan requirement are those entities requesting support
    ONLY for basic local and long distance telephone service.

    **Item 26** - Check the box that best describes the level of
    technology plan.

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-   **Item 26a -** Check here if the eligible entities are covered by
    [individual]{.underline} technology plans for the services requested
    in your application.

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-   **Item 26b -** Check here if the eligible entities are covered by a
    [higher-level, multi-entity]{.underline} technology plan, such as a
    school district or library system plan. Statewide technology plans
    are not acceptable.

-   **Item 26c -** Check here if your application is ONLY for basic
    local and long distance telephone service, in which case no
    technology plan is required.

    **Item 27** - Check the box that best describes the status of the
    technology plan.

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-   **Item 27a -** Check here if your technology plan has been approved.

-   **Item 27b -** Check here if you are currently seeking approval of
    your technology plan(s) from a state or other authorized body.

-   **Item 27c -** Check here if your application is ONLY for basic
    local and long distance telephone service, since no technology plan
    is required.

    **Item 28** - Certify that you have complied with all applicable
    state and local laws or rules regarding procurement. The FCC's rules
    are not intended to preempt state or local procurement rules.

    **Item 29 -** Certify that services ordered pursuant to the
    universal service discount mechanism will be used for educational
    purposes only and that the services will not be sold, resold, or
    transferred in consideration for money or any other thing of value.

    **Item 30** - Certify that you have complied with all program rules
    and that you acknowledge failure to do so may result in denial of
    discount funding and/or cancellation of funding commitments.

    **Item 31** - 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 that are
    treated as sharing in the shared services receive an appropriate
    share of benefits from those services, as defined by the FCC.

    **Item 32** - Certify that you are aware that you may be audited to
    ensure that the information that you are providing in this form is
    accurate and that you are abiding by all of the relevant
    regulations. You must also commit to retain any and all worksheets
    and other records that you have relied upon to fill out Form 471 for
    five years so that an auditor can verify the accuracy of the
    information you provide. This includes all documentation showing
    that you have complied with all applicable competitive bidding
    requirements, including copies of competing bids and documentation
    of the bid evaluation process and bid criteria used. Thus, if
    applicants represent multiple billed entities, collect data from
    those entities, and add up that data, they should retain those data
    sheets for five years. If an applicant is audited, it should be
    prepared to make the worksheets and other records used to compile
    these forms available to the auditor and/or the administrator, and
    it should be able to demonstrate to the auditor and/or the
    Administrator how the entries in its application were provided.

    **Item 33** - Certify that you are the person authorized to submit
    and certify to the accuracy of this form. This person must be
    authorized to represent any and all of the entities for which
    discounts are sought in this application. Documentation to confirm
    this person's authorization to represent all entities in this
    application may be sought by the Fund Administrator during review of
    this application. For example, for consortium applications, the
    consortium lead member must either collect Letters of Agency from
    each consortium member or be able to provide some other proof that
    each consortium member knew it was represented on the application.
    Consortia that have a statutory or regulatory basis and for which
    participation is mandatory must be able to provide documentation
    supporting this certification. For consultants or other signers who
    are not employees of the Billed Entity, those individuals must also
    have a Letter of Agency from the applicant affirming that they are
    authorized to represent the applicant. For more information, please
    refer to "Letters of Agency" on the SLD web site at
    www.sl.universalservice.org.

    **Item 34** requires the signature of the authorized person.

    **Item 35** requires that the date of signature of the Form 471 be
    provided. Please note that for applications requesting new services,
    this date CANNOT be earlier than any Allowable Vendor
    Selection/Contract Date you cited in Item 17 of any Block 5
    submitted with this application.

    **Item 36** (30 characters maximum) - Print the name of the
    authorized person whose signature is provided in Item 34.

    **Item 37** (30 characters maximum) **-** Provide the title or
    position of the authorized person whose signature is provided in
    Item 34.

    **Item 38 -** Provide the telephone number, including area code, of
    the authorized person whose signature is provided in Item 34.

    **V. REMINDERS**

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-   All schools and libraries ordering services eligible for universal
    service discounts must file Form 471 each time they order
    telecommunications services, Internet access, and internal
    connections for which they are requesting discounts.

-   Form 470 must be posted to the SLD web site for at least 28 days
    before filing Form 471.

-   If you are applying for both Priority 1 (Telecommunications Services
    or Internet Access) and Priority 2 (Internal Connections) services,
    you are strongly encouraged to file these requests on separate Forms
    471 --- that is, to file one or more Forms 471 for your Priority 1
    requests and one or more Forms 471 for your Priority 2 requests.

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-   For Funding Year 2003, the application window will open at noon EST
    on Monday, November 4, 2002 and close at 11:59 p.m. EST on January
    16, 2003.

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-   The authorized individual representing the entity that pays the
    bills for ordered telecommunications and other supported services
    for the school, school district, or libraries, or consortium must
    sign the Form 471 or certify it online.

-   Provide data for all items that apply. For items that do not apply,
    fill in \"N/A.\"

-   Attach additional sheets if necessary. Any attachments to Form 471
    should be clearly labeled. In addition, your attachments for Item 21
    description of services must be clearly labeled with Attachment
    Numbers assigned by you.

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-   If you are filing Blocks 1-5 of Form 471 online, you must also
    complete and submit your Block 6 Certification (whether online or on
    paper), your Item 21 description of services and any other
    attachments. If you have not already done so, you must also submit
    the Block 5 certification of any Form 470 cited in a Funding Year
    2003 Form 471 with the signature of the authorized person.

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-   The Fund Administrator will notify the Form 471 applicant after our
    review of your application has been completed.

-   The Fund Administrator will not provide funds to service providers
    for any service until FCC Form 486 is filed for that service,
    indicating that the service recipient's technology plan(s) (if
    necessary) has/have been approved (unless the recipient seeks only
    basic local and long distance telephone service) and that service
    has begun to be provided or that the recipient has confirmed with
    the service provider that services are schedule to begin in July of
    the funding year (early filing).

-   You may be audited to ensure that the information that you are
    providing in this form is accurate and that you are abiding by all
    of the relevant regulations.