Appendix A DA 20-1529 Certification I certify that I am [Enter Office Title] of [Enter Exact Legal Name of Respondent] and that I have examined the responses to the Lifeline Data Collection Questionnaire, and that to the best of my knowledge and belief, all responses to the Questionnaire are true, correct, and complete. Signature: [Enter Digital Signature] Full Name: [Enter Full Name] Date: [Enter Date in MM/DD/YY Format] Telephone Number: [Enter Telephone Number] E-mail Address: [Enter E-mail Address] SAMPLE Willful false statements in responses to this information collection are punishable by fine and/or imprisonment (U.S. Code, Title 18, Section 1001). DRAFT A-1 Final version will be sent to respondents via email Appendix A DA 20-1529 For each calendar year, report the number of customers in each usage category listed below: Table 1.1 2016 2017 2018 2019 2020 Total customers who average Less than 1 GB usage per month Total customers who average more than or equal to 1 GB & less than 2 GB usage per month Total customers who average more than or equal to 2 GB & less than 3 GB usage per month Total customers who average more than or equal to 3 GB & less than 4 GB usage per month Total customers who average more than or equal to 4 GB & less than 5 GB usage per month SAMPLE Total customers who average more than or equal to 5 GB & less than 6 GB usage per month Total customers who average more than or equal to 6 GB & less than 8 GB usage per month Total customers who average more than or equal to 8 GB & less than 10 GB usage per month Total customers who average more than or equal to 10 GB & less than 15 GB usage per month Total customers who average more than or equal to 15 GB & less than 20 GB usage per month Total customers who average more than or equal to 20 GB usage per month Total customers who average less than 250 minutes usage per month Total customers who average more than or equal to 250 minutes & less than 500 minutes usage per month Total customers who average more than or equal to 500 minutes & less than 750 minutes usage per month Total customers who average more than or equal to 750 minutes & less than 1,000 minutes usage per month Total customers who average more than or equal to 1,000 minutes & less than 1,250 minutes usage per month Total customers who average more than or equal to 1,250 minutes & less than 1,500 minutes usage per month Total customers who average more than or equal to 1,500 minutes & less than 2,000 minutes usage per month Total customers who average more than or equal to 2,000 minutes usage per month DRAFT A-2 Final version will be sent to respondents via email Appendix A DA 20-1529 For each calendar year, report the number of Lifeline customers in each usage category listed below: Table 1.2 2016 2017 2018 2019 2020 Total Lifeline customers who average Less than 1 GB usage per month Total Lifeline customers who average more than or equal to 1 GB & less than 2 GB usage per month Total Lifeline customers who average more than or equal to 2 GB & less than 3 GB usage per month Total Lifeline customers who average more than or equal to 3 GB & less than 4 GB usage per month Total Lifeline customers who average more than or equal to 4 GB & less than 5 GB usage per month SAMPLE Total Lifeline customers who average more than or equal to 5 GB & less than 6 GB usage per month Total Lifeline customers who average more than or equal to 6 GB & less than 8 GB usage per month Total Lifeline customers who average more than or equal to 8 GB & less than 10 GB usage per month Total Lifeline customers who average more than or equal to 10 GB & less than 15 GB usage per month Total Lifeline customers who average more than or equal to 15 GB & less than 20 GB usage per month Total Lifeline customers who average more than or equal to 20 GB usage per month Total Lifeline customers who average less than 250 minutes usage per month Total Lifeline customers who average more than or equal to 250 minutes & less than 500 minutes usage per month Total Lifeline customers who average more than or equal to 500 minutes & less than 750 minutes usage per month Total Lifeline customers who average more than or equal to 750 minutes & less than 1,000 minutes usage per month Total Lifeline customers who average more than or equal to 1,000 minutes & less than 1,250 minutes usage per month Total Lifeline customers who average more than or equal to 1,250 minutes & less than 1,500 minutes usage per month Total Lifeline customers who average more than or equal to 1,500 minutes & less than 2,000 minutes usage per month Total Lifeline customers who average more than or equal to 2,000 minutes usage per month DRAFT A-3 Final version will be sent to respondents via email Appendix A DA 20-1529 For each calendar year, report the following: Table 1.3 2016 2017 2018 2019 2020 Average number of customers per month with a monthly data usage allowance Average number of customers per month who exceeded their monthly data usage allowance For customers who exceeded their data allowance, what was the average per month, per subscriber they exceeded it by? Average number of Lifeline customers per month with a monthly data usage allowance Average number of Lifeline customers per month who exceeded their monthly data usage allowance SAMPLE For Lifeline customers who exceeded their data allowance, what was the average per month, per subscriber they exceeded it by? Average number of customers per month without a monthly data usage allowance Average number of Lifeline customers per month without a monthly data usage allowance DRAFT A-4 Final version will be sent to respondents via email Appendix A DA 20-1529 Network Costs: For each calendar year, report the costs paid to network operators for network access for your customers: Table 2.1 2016 2017 2018 2019 2020 Total GB purchased Total amount paid for wholesale GB Total wholesale minutes purchased Total amount paid for wholesale minutes Total GB purchased for Lifeline customers SAMPLE Total amount paid for wholesale GB for Lifeline customers Total wholesale minutes purchased for Lifeline customers Total amount paid for wholesale minutes for Lifeline customers DRAFT A-5 Final version will be sent to respondents via email Appendix A DA 20-1529 Answer yes or no for the following questions: Table 2.2 2.2a Do wholesale rates for minutes and/or GB vary if you purchase higher quantities? (if yes, fill out Table 2.3) 2.2b Do wholesale rates for minutes and/or GB vary if they are purchased specifically for Lifeline subscribers? (If yes, fill out Table 2.4) 2.2c Do wholesale rates for minutes and/or GB vary by geographic area? (If yes, fill out Table 2.5) 2.2d Did you incur any network costs other than the wholesale cost of minutes and/or data and excluding overhead costs (e.g., fixed payments made to the network operator, or network costs incurred by the MVNO)? (If yes, fill out Table 2.6) 2.2e Do any of the above additional network costs depend on Lifeline usage/or subscribership? (If yes, fill out Table 2.7) 2.2f Do any of these additional network costs vary by geography? (If yes, fill out Table 2.8) 2.2g Do you incur network costs for GB that were available to a customer in their data allowance but were never used? (If yes, fill out Table 2.9) 2.2h If you answered yes to 2.2g, are those specific costs included in Table 2.1, rows 8 through 11? DRAFT A-6 Final version will be sent to respondents via email Appendix A DA 20-1529 If 2.2a is yes fill out Table 2.3: Please describe in detail any volume discount you received for purchasing a larger quantity of wholesale GB or minutes: Table 2.3 Unique Identifier (i.e. Quantity threshold for Applicable to Price Variation (i.e. Applicable Additional Information price or discount code) price variation (i.e. minutes or GB surcharge or discount years [Optional] surrchage or discount) amount) SAMPLE DRAFT A-7 Final version will be sent to respondents via email Appendix A DA 20-1529 If 2.2b is yes fill out Table 2.4: Table 2.4 Describe in detail any discount you received (or price variation you incurred) for purchasing a wholesale GB or minutes specifically for Lifeline subscribers: DRAFT A-8 Final version will be sent to respondents via email Appendix A DA 20-1529 If 2.2c is yes fill out Table 2.5: Please describe in detail any discount you received (or price variation you incurred) for purchasing a wholesale GB or minutes in each relevant geographic area Table 2.5 Unique Identifier (i.e. Geographic Area (e.g., the regions, states, Applicable to Price Variation (i.e. Applicable years Additional Information price or discount code) MSAs, counties, ZIP codes) minutes or GB surcharge or discount [Optional] amount) SAMPLE DRAFT A-9 Final version will be sent to respondents via email Appendix A DA 20-1529 If 2.2d is yes fill out Table 2.6: Please describe in detail your additional network costs (excluding wholesale Min/GB and overhead costs) Table 2.6 Year Cost Type Cost Amount Additional Information SAMPLE DRAFT A-10 Final version will be sent to respondents via email Appendix A DA 20-1529 If 2.2e is yes fill out Table 2.7: Table 2.7 Explain how and why your additional network costs depend on Lifeline usage/or subscribership: DRAFT A-11 Final version will be sent to respondents via email Appendix A DA 20-1529 If 2.2f is yes fill out Table 2.8: Please explain how and why your additional network costs vary by geography: Table 2.8 Geographic Area Cost Type Cost Any additional information or explanation (i.e. years these costs were or were not applicable in each geographic region): SAMPLE DRAFT A-12 Final version will be sent to respondents via email Appendix A DA 20-1529 If 2.2g is yes fill out Table 2.9: Table 2.9 2016 2017 2018 2019 2020 Total GB purchased for Lifeline customers that were not used by a Lifeline end-user Total amount paid for wholesale GB for Lifeline customers that were not used by a Lifeline end-user Total wholesale minutes purchased for Lifeline customers that were not used by a Lifeline end-user Total amount paid for wholesale minutes for Lifeline customers that were not used by a Lifeline end-user SAMPLE DRAFT A-13 Final version will be sent to respondents via email Appendix A DA 20-1529 Network Costs and Wholesale Prices: For each calendar year, report the following: Table 3.1 2016 2017 2018 2019 2020 Total GB sold Total amount received for wholesale GB Total wholesale minutes sold Total amount received for wholesale minutes Total GB sold for Lifeline customers use Total amount received for wholesale GB for Lifeline SAMPLE customers use Total wholesale minutes sold for Lifeline customers use Total amount received for wholesale minutes for Lifeline customers use DRAFT A-14 Final version will be sent to respondents via email Appendix A DA 20-1529 Answer yes or no for the following questions: Table 3.2 3.2a Do your wholesale prices for minutes and/or GB vary for higher quantity amounts purchased? (If yes, fill out Table 3.3) 3.2b Do your wholesale prices for minutes and/or GB differ by geographic regions or areas? (If yes, fill out Table 3.4) 3.2c Do you have any additional variation in pricing, including, for example, limits on Lifeline customer usage? (If yes, fill out Table 3.5) DRAFT A-15 Final version will be sent to respondents via email Appendix A DA 20-1529 If 3.2a is yes fill out Table 3.3: Please describe in detail any volume discounts you offer for larger quantity of wholesale GB or minutes sold: Table 3.3 Unique Identifier (i.e. price Quantity threshold for price Applicable to Price Variation (i.e. Applicable Additional Information or discount code) variation (i.e. surrchage or minutes or GB surcharge or discount years [Optional] discount) amount) SAMPLE DRAFT A-16 Final version will be sent to respondents via email Appendix A DA 20-1529 If 3.2b is yes fill out Table 3.4: Please describe in detail any regional or geographic specific discounts you offer: Table 3.4 Unique Identifier (i.e. price Geographic Area (e.g., the Applicable to Price Variation (i.e. Applicable Additional Information or discount code) regions, states, MSAs, counties, minutes or GB surcharge or discount years [Optional] ZIP codes) amount) SAMPLE DRAFT A-17 Final version will be sent to respondents via email Appendix A DA 20-1529 If 3.2c is yes fill out Table 3.5: Table 3.5 Describe in detail your additional variation in pricing, specifically for Lifeline subscribers: DRAFT A-18 Final version will be sent to respondents via email Appendix A DA 20-1529 For each calendar year, report your average network costs per month per user: Table 3.6 2016 2017 2018 2019 2020 Average Network Costs per month per user Average Network Costs per month per user in Urban / Non- Tribal areas Average Network Costs per month per user in Urban / Tribal areas Average Network Costs per month per user in Rural / Non- Tribal areas Average Network Costs per SAMPLE month per user in Rural / Tribal areas DRAFT A-19 Final version will be sent to respondents via email Appendix A DA 20-1529 Table 3.7 Explanation Explanation on why network costs vary year to year Explanation for cost differences &/or allocations in Urban / Non-Tribal areas Explanation for cost differences &/or allocations in Urban / Tribal areas Explanation for cost differences &/or allocations Rural / Non-Tribal areas Explanation for cost differences &/or allocations SAMPLE in Rural / Tribal areas DRAFT A-20 Final version will be sent to respondents via email Appendix A DA 20-1529 For each calendar year, report your total overhead costs and the average customers supported by those overhead costs each month: (Costs should include all operating costs other than network costs, and should exclude the cost of capital and interest; depreciation and amortization; capital expenditures; and adjustments to balance sheet values.) Table 4.1 2016 2017 2018 2019 2020 Total Overhead Costs per Month Average number of Users Supported per month Additional overhead costs per Lifeline customer per month Explanation of Cost Difference of Lifeline customer SAMPLE DRAFT A-21 Final version will be sent to respondents via email Appendix A DA 20-1529 Answer yes/no to the following questions: Table 4.2 4.2a Do the overhead costs reported include marketing costs? 4.2b Do the overhead costs reported include sales costs? 4.2c Do the overhead costs reported include billing costs? 4.2d Do the overhead costs reported include advertising costs? 4.2e Do the overhead costs reported include administrative costs? 4.2f Do the overhead costs reported include in-person promotional event costs? 4.2g Do the overhead costs reported include promotional items (e.g. t-shirts, handsets, headphones)? 4.2h Are there any other items included in overhead costs that are not listed above: DRAFT A-22 Final version will be sent to respondents via email Appendix A DA 20-1529 If 4.2h is yes fill out Table 4.3: Table 4.3 Explain in detail the additional overhead costs categories included in your totals. DRAFT A-23 Final version will be sent to respondents via email