Illinois Administrative Code › Title 83 - PUBLIC UTILITIES › Part 757 - TELEPHONE ASSISTANCE PROGRAMS › Subpart F - BIAS ASSISTANCE › Exhibit A - LEC and ETC Quarterly Report to Commission

Current through Register Vol. 48, No. 28, July 12, 2024
LIFELINE AND
UNIVERSAL TELEPHONE SERVICE ASSISTANCE
				  PROGRAMS
QUARTERLY REPORT TO THE ILLINOIS COMMERCE
				  COMMISSION
Company _______________________
Mailing _________________________
Address ________________________
Contact Name ___________________
Telephone ______________________
Date of Submission ________
Data Period: Year _________
Quarter: 1st
							 2nd 3rd
							 4th
Type of Filing: Original Correction
Service Type: Wireline Wireless
Program
(a)
Month:
____
(b)
Month:
____
(c)
Month:
____
(d)
Quarter Totals
____
(e)
Year-to-Date Totals:
____
1.0 UTSAP INSTALLATION WAIVER
1.1 Number of applications
							 approved during the month
____
____
____
____
____
1.2 Number of customers for whom supplemental local
							 exchange service installation charges were waived during the month
____
____
____
____
____
1.3 Supplemental local
							 exchange service installation charges waived
$ ____
$ ____
$ ____
$ ____
$ ____
2.0 LIFELINE - FEDERAL
2.1 Number of Federal Lifeline customers at end of
							 month
____
____
____
2.2 Number of Illinois Federal Lifeline applications
							 approved during the month
____
____
____
____
____
2.3 Number of Illinois Federal Lifeline customers added
							 during the month
____
____
____
____
____
2.4 Number of Illinois Federal Lifeline customers lost
							 during the month
____
____
____
____
____
2.5 Total Illinois Federal Lifeline Assistance
$ ____
$ ____
$ ____
$ ____
$ ____
3.0 LIFELINE - UTSAP SUPPLEMENTAL MONTHLY
							 ASSISTANCE
3.1 Number of UTSAP funded Lifeline customers at end of
							 month
** ____
____
____
3.2 Number of UTSAP funded Lifeline applications approved
							 during the month
____
____
____
____
____
3.3 Number of UTSAP funded Lifeline customers added during
							 the month
$ ____
$ ____
$ ____
$ ____
$ ____
3.4 Number of UTSAP funded Lifeline customers lost during
							 the month
____
____
____
____
____
3.5 UTSAP funded total Lifeline Supplemental
							 Assistance
____
____
____
____
____
NOTES:
a) Each LEC must file the original of this Exhibit A with the
				  Chief Clerk of Illinois Commerce Commission and forward a copy to the UTSAP
				  Administrator and the Staff Liaison within 30 days after the end of each calendar
				  quarter. Each ETC, if not otherwise required by this Part, shall complete the
				  "LIFELINE AND UNIVERSAL TELEPHONE SERVICE ASSISTANCE PROGRAMS QUARTERLY REPORT TO
				  THE ILLINOIS COMMERCE COMMISSION" portion of this Exhibit A and file an original of
				  this report with the Chief Clerk of the Illinois Commerce Commission within 30 days
				  after the end of each calendar quarter unless the ETC participates solely in BIAS
				  programs subject to this Part.
b) A Lifeline customer should be counted as approved during the
				  month if the LEC accepts the customer for participation in the Lifeline Program
				  during the month. A Lifeline customer should be counted as added during a month if
				  the LEC provided an initial Lifeline subsidy to the customer during the month and
				  claimed reimbursement for the subsidy. Please note that counts of approved and added
				  customers will differ to the extent that customers approved in a month are not added
				  (i.e., provided service and Lifeline subsidies) until subsequent months. A Lifeline
				  customer should be counted as lost during a month if the LEC ceased providing the
				  Lifeline subsidy to the customer during the month and did not claim reimbursement
				  for the subsidy.
QUARTERLY REPORT TO THE ILLINOIS COMMERCE
							 COMMISSION
STATUS OF UTSAP EXPENDITURES
LOCAL EXCHANGE COMPANY:
							 _____________________________________
FOR CALENDAR QUARTER ENDING:
							 ________________________________
UTSAP EXPENDITURE REPORT
Current Quarter
Year to Date*
1.
Telecommunications Expenses
a. Billing and Data Processing
$ ____
$ ____
b. Customer Notification and Bill Inserts
____
____
c. Certification Administration (LEC) and Contact
							 Time
____
____
(Total of Lines 1-6 below)
1. Salaries & Fringe Benefits
____
____
2. Materials
____
____
3 Postage
____
____
4. Transportation Expenses
____
____
5. Preprinted Forms
____
____
6. Other
____
____
d. Certification Administration (IDPA/SSI)
____
____
e. Service Representative Training
____
____
f. Other, please specify
____
____
__________________________________
TOTALS
$ ____
$ ____
Less UTSAP Reimbursement Received
$ ____
$ ____
BALANCES
$ ____
$ ____
*
Includes Current Quarter
Note:
Each Local Exchange Company must file the original of this
							 Exhibit A with the Chief Clerk of the Illinois Commerce Commission and forward a
							 copy to the UTSAP Administrator and the Staff Liaison within 30 days after the end
							 of each calendar quarter. Expenses associated with the Federal Lifeline Program
							 should not be reported on this form.
LECs shall maintain supporting documentation in such a
							 manner as to be able to readily identify the above expenses in appropriate
							 subaccounts.
Quarterly "Totals" reported on this page should correspond
							 to the sum of the monthly "Administrative Costs" reported on Exhibit B by LECs with
							 over 35,000 access lines.