*Pages 1--31 from Microsoft Word - 22617.doc* FCC Form 471 Instructions - October 2002 - Page 1 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 KEY INFORMATION € File your Form 471 online. This speeds the processing of your form and reduces errors. € See if you qualify for E- certification. (See the “Special Block 6 Instructions for Applications Filed Online.”) If you do, obtain a User ID and a PIN and certify your Form 471 online as well. € File requests for Priority 1 and Priority 2 services on separate Forms 471. (See “When, Where, and How Many Forms 471 to File.”) € If you are filing on paper, review the “MINIMUM PROCESSING STANDARDS AND FILING REQUIREMENTS” for Manual Filers. € Note the new methodology for libraries to calculate their discount percentages. (See the instructions for Block 4, Worksheet B.) € Note the detailed information provided in the specific instructions for Item 25. € Remember that the Form 471 application filing window for Funding Year 2003 closes at 11: 59 PM EST on January 16, 2003. See the “Filing Requirements for Forms 471 Submitted on Paper and Online.” 1 FCC Form 471 Instructions - October 2002 - Page 2 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 2 FCC Form 471 Instructions - October 2002 - Page 3 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 3 FCC Form 471 Instructions - October 2002 - Page 4 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 4 FCC Form 471 Instructions - October 2002 - Page 5 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. € 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: € 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. 5 FCC Form 471 Instructions - October 2002 - Page 6 C. 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. 6 FCC Form 471 Instructions - October 2002 - Page 7 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; 7 FCC Form 471 Instructions - October 2002 - Page 8 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 8 FCC Form 471 Instructions - October 2002 - Page 9 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 9 FCC Form 471 Instructions - October 2002 - Page 10 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 through June 30, 2004). 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) 10 FCC Form 471 Instructions - October 2002 - Page 11 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. 11 FCC Form 471 Instructions - October 2002 - Page 12 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. 12 FCC Form 471 Instructions - October 2002 - Page 13 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 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 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. € 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 13 FCC Form 471 Instructions - October 2002 - Page 14 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 14 FCC Form 471 Instructions - October 2002 - Page 15 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 Measured by % of students eligible for the National School Lunch Program URBAN LOCATION Discount RURAL LOCATION Discount If the percentage of students in your school that qualifies for the National School Lunch Program is… …and you are in an URBAN area, your discount will be… …and you are in a RURAL area, your 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. 15 FCC Form 471 Instructions - October 2002 - Page 16 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. € 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. 16 FCC Form 471 Instructions - October 2002 - Page 17 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. 17 FCC Form 471 Instructions - October 2002 - Page 18 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. € 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 18 FCC Form 471 Instructions - October 2002 - Page 19 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. € 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: 19 FCC Form 471 Instructions - October 2002 - Page 20 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. € 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. € 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. € 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: € 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. 20 FCC Form 471 Instructions - October 2002 - Page 21 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. € 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 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. 21 FCC Form 471 Instructions - October 2002 - Page 22 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. € 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. € 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. 22 FCC Form 471 Instructions - October 2002 - Page 23 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. 23 FCC Form 471 Instructions - October 2002 - Page 24 The line- item listing of products and services may be submitted in a table format as follows: ----- Extended Cost----- Quantity Description of Product or Service Unit 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. 24 FCC Form 471 Instructions - October 2002 - Page 25 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. € 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. 25 FCC Form 471 Instructions - October 2002 - Page 26 € 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. 26 FCC Form 471 Instructions - October 2002 - Page 27 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. € You must also submit the Block 6 certification. € 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. € 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 27 FCC Form 471 Instructions - October 2002 - Page 28 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 28 FCC Form 471 Instructions - October 2002 - Page 29 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. € Item 26a - Check here if the eligible entities are covered by individual technology plans for the services requested in your application. € Item 26b - Check here if the eligible entities are covered by a higher- level, multi- entity 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. € 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. 29 FCC Form 471 Instructions - October 2002 - Page 30 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. 30 FCC Form 471 Instructions - October 2002 - Page 31 V. REMINDERS € 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. € 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. € 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. € 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. € 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. 31