form 486 step-by-step receipt of service confirmation train-the-trainer workshop september 17-18,...

Form 486 Step-by-StepReceipt of Service

Confirmation

Train-the-Trainer WorkshopSeptember 17-18, 2001

Schools & Libraries Division, USAC

Schools & Libraries Division, USACSeptember 17-18, 2001 2

The information on this slide is believed to betrue and accurate as of September 4, 2001.

Form 486 – Receipt of Service Confirmation Form

Purpose Informs SLD when the Billed Entity and/or the

eligible entities it represents is receiving, is scheduled to receive, or has received service

Receipt by SLD triggers the process for SLD to receive invoices Universal service support will not be paid to a Service

Provider on an approved funding commitment prior to the SLD’s receipt of the Form 486




Purpose (cont.) Form 486 must be filed to accomplish the

following: To authorize the payment of invoices from your Service

Provider(s) To indicate approval of Technology Plans (as required) To indicate, starting in Funding Year 4, the status of

compliance with the Children’s Internet Protection Act (CIPA)




Impact of CIPA Requirements Beginning with Funding Year 4, the Children’s Internet

Protection Act (CIPA) requirements apply to Internet Access and Internal Connections requests Although CIPA requirements do not apply to Telecommunications

Services, Billed Entities applying only for Telecommunications Services must still, in general, make certifications to that effect

Certifications for the purpose of CIPA for Telecommunications Services, Internet Access and Internal Connections are featured on Form 486




Who must make the CIPA certification? The Administrative Authority for a school or library is the

entity that must make the relevant certification If the Administrative Authority is also the Billed Entity,

the Administrative Authority certifies on the Form 486 If the Administrative Authority is not the Billed Entity,

the Administrative Authority must complete Form 479 and submit Form 479 to the Billed Entity




Who Must File the Form 486? The Billed Entity representing a school,

school district, library (outlet/branch, system), or a consortium of those entities who completed and submitted the Form 471 to which the Form 486 relates




How Many Forms 486 to File? Early filing

You may have one or more early Forms 486 and one or more later Forms 486

Timing of start dates If multiple FRNs have the same or similar

start dates for service, you may file one Form 486 for all of those FRNs




How Many Forms 486 to File? (cont.) Availability of information

All components of information are required to be completed

If required information for a particular FRN is missing, a separate Form 486 should be submitted for that FRN

Your Form 486 may be rejected and returned to you without being accepted and processed if information is missing




How Many Forms 486 to File? (cont.) You must complete a separate Form 486 if:

You receive Funding Commitment Decision Letters (FCDLs) featuring more that one entity number

The Item 11a certification applies to certain FRNs and the Item 11b certification applies to other FRNs (for Funding Year 4 and later)

You file a waiver of CIPA requirements for a portion of your funded FRNs (for Funding Year 5 and later)




When to File? No earlier than the receipt of an FCDL Funding Years 1, 2, and 3

Should file within ten days of the start of services

Funding Year 4 and later See CIPA presentation for detailed information on

deadlines for Funding Year 4 and later




Where to File? File with Schools and Libraries Division

Manually, mailing address (P.O. Box):SLD - Form 486

P.O. Box 7026Lawrence, KS 66044-7026




Where to File? (cont.) File with Schools and Libraries Division

Manually (Express delivery or U.S. Postal Service Return Receipt)

SLD - Form 486c/o Ms. Smith3833 Greenway DriveLawrence, KS 66046Telephone number for receipt purposes: 888-203-8100




Compliance Schools and libraries filing false information are

subject to penalties Applicants should retain the records they use to

complete these forms for five years If applicants represent multiple entities, the data

collected from those entities must also be kept for five years



Form 486: Top of Form, page 1

Data are used to help both applicant and SLD identify each Form 486 you file Do Not Write In This Area: Space is used to apply a

barcode upon receipt to track and archive your form Applicant’s Form Identifier: Use this space to assign a

number or letter of your own devising to facilitate communication with SLD about THIS particular Form 486.

Form 486 Application #: The SLD will insert your Form 486 number. Leave this item blank.



Form 486: Top of Form, pages 2-5

Top of each page after page 1: To help alleviate problems caused if pages of the application become separated, please provide: Entity Number (from Item 2 below) Applicant’s Form Identifier (from Top of Form, page 1) Name of Contact Person (from Item 5 below) Contact Person Telephone Number (from Item 5 below)



Form 486, Block 1:Billed Entity Information

Item 1 – Name of Billed Entity Provide the name of the Billed Entity as

indicated on the corresponding Funding Commitment Decision Letter (FCDL)

Item 2 – Billed Entity Number Provide the Billed Entity Number as it

appears on your FCDL




Item 3 – Funding Year Provide the Funding Year for which your

funds were approved, e.g., “07/01/2001–06/30/2002”

The Funding Year must be the same as the Funding Year contained in your FCDL for the corresponding Form 471

Cite only one Funding Year in this item




Item 4 – Complete Mailing Address of Billed Entity Street Address, P.O. Box or Route Number, City, State, Zip

Code You are strongly encouraged to provide a street address

rather than a P.O. Box if possible 10-Digit Telephone Number (plus extension) Fax Telephone Number (10 digits) E-Mail Address (50 characters maximum)




Item 5 – Contact Person Information Contact Person Name

Provide the name of the person who should be contacted with questions about this form

Contact Person Mailing Address (if different from Item 4) Provide the mailing address for the Contact Person, and

10-digit telephone number, fax number, and e-mail address if different from the information in Item 4

Check the preferred mode of contact



Form 486, Block 2a:FUNDING YEAR 4 ONLY –Early Filing Information

Item 6A – Early Filing for Funding Year 4 Check this box if you wish to file your Form 486 before

services have started in Funding Year 4. You may file early if: You have received your FCDL You have confirmed with the named Service Provider

that services you ordered will start on the Service Start Date, which must be on or before October 28, 2001

You are able to accurately make all relevant certifications in Block 4, and



Form 486, Block 2a:FUNDING YEAR 4 ONLY –Early Filing Information

Item 6A – Early Filing for Funding Year 4 (cont.) Your Form 486, including your certification in

Item 11, must be postmarked on or before October 28, 2001

If you are submitting Form 486 after services have started, do not check this box



Form 486, Block 2b:FUNDING YEARS AFTER FUNDING YEAR 4 –

Early Filing Information & CIPA Waiver Request

Item 6B – Early Filing after Funding Year 4 Check this box if you wish to file your Form 486 before

services have started in Funding Years after Funding Year 4. You may file early if: You have received your FCDL You have confirmed with the named Service Provider that the

services you ordered will start on the Service Start Date, which must be on or before July 31 of the relevant Funding Year

You are able to accurately make all relevant certifications in Block 4





Item 6B – Early Filing after Funding Year 4 (cont.) Your Form 486, including your certification in

Item 11, must be postmarked on or before July 31 of the relevant Funding Year

If you are submitting Form 486 after services have started, do not check this box





Item 6C – CIPA Waiver Request If you are a Billed Entity who is also the

Administrative Authority for the purpose of CIPA, you must check this item if you need to request a waiver from CIPA requirements in the Second Funding Year in which you “apply” for funds (See CIPA presentation for further details)



Form 486, Block 3:Service Information

Item 7 – Service Information Provide the information for each Form 471 Block 5

(Discount Funding Request). This information must be obtained from the FCDL sent to you by SLD. Column (A) – 471 Application Number Column (B) – FRN for the services to be provided Column (C) – Billing Account Number (if contained in your

FCDL) Column (D) – Service Provider Name Column (E) – Service Provider Identification Number (SPIN)



Form 486, Block 3:Service Information

Item 7 – Column F, Funding Year Service Start Date For each FRN, provide the date on which the

service for that FRN started or, in certain circumstances, is scheduled to start

In no instance can this date be earlier than July 1 of the relevant Funding Year

The FRNs listed must be from the same Funding Year as is listed in Block 1, Item 3



Form 486, Block 4:Certifications and Signature

Item 8 – Technology Plan Certifications Certify that the technology plan(s) covering the services listed for

all the eligible entities who are recipients of services covered under your Form 486 have been approved by an authorized organization(s) certified by the SLD

Provide the name(s) of the organization(s) who are the technology plan approver(s) that approved a technology plan for any eligible entity receiving services covered under your Form 486

If EVERY FRN listed in the Form 486 is for basic telephone service only, enter “none.”




Item 9 – Services Certifications Certify that the services listed on this Form 486 are planned to

be or are being provided to the eligible entities identified in the Form 471 application(s) cited in this Form 486

Certify that there are signed contracts covering all the services listed except for those services provided under tariff or on a month-to-month basis

Certify that the individual signing on behalf of the Billed Entity is authorized to submit the information and that all statements of fact contained in Form 486 are true




Item 10 – Shared Service and Audit Certifications 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 treated as sharing in the services receive an appropriate share of benefits from those services

Certify that you recognize that you may be audited pursuant to this application; that you will retain for five years any and all records that you rely upon to complete this form and, if audited, that you will make available to the SLD such records




Item 11 – CIPA Certifications This item concerns compliance with the

requirements of the Children’s Internet Protection Act (CIPA)

If this Form 486 pertains to a Funding Year prior to Funding Year 4, skip Item 11 and go to Item 12

If this Form 486 pertains to Funding Year 4 or later, Item 11 must be completed




Item 11 – CIPA Certifications (cont.) General Instructions

A Billed Entity who is a recipient of service must check Item 11a or 11b or 11c

A Billed Entity who represents one or more Administrative Entities must check Item 11d or 11e

For Funding Years after Funding Year 4, a Billed Entity who must collect Forms 479 and who checks Item 11d must check Item 11f or 11g




Item 11 – CIPA Certifications (cont.) For a Billed Entity who is the Administrative Authority

Check Item 11a if you certify that the recipients of service have complied with CIPA requirements

Check Item 11b if you certify that the recipients of service are undertaking actions to comply with CIPA for the next Funding Year, but have not completed all requirements of CIPA for this Funding Year




Item 11 – CIPA Certifications (cont.) For a Billed Entity who is the Administrative Authority

Check Item 11c if you certify that CIPA does not apply because the recipients of service are receiving discount services only for Telecommunications Services

Remember to check only the ONE box in Items 11a through 11c that describes the status of compliance with CIPA




Item 11 – CIPA Certifications (cont.) For a Billed Entity who represents one or more

Administrative Authorities Check Item 11d if you certify, as the Billed Entity for the

consortium or for the Administrative Authorities you represent, that you have collected duly completed and signed Forms 479

Check Item 11e if you certify, as the Billed Entity for the consortium or for the Administrative Authorities you represent, that the only services for which you have been approved for discounts are Telecommunications Services, and therefore the requirements of CIPA do not apply




Item 11 – CIPA Certifications (cont.) For a Billed Entity who represents one or more

Administrative Authorities For Funding Years after Funding Year 4: Check Item 11f if you

certify, as the Billed Entity for the Administrative Authorities you represent, that some or all of the entities who filed Form 479 are seeking a CIPA Waiver by checking Form 479 Item 6d

For Funding Years after Funding Year 4: Check Item 11g if you certify, as the Billed Entity for the Administrative Authorities you represent, that none of the entities who filed Form 479 is seeking a CIPA Waiver by checking Form 479 Item 6d




Items 12-16 – Authorized Signature The Authorized Person must sign the form using

an original ink signature in Item 12 and provide: Item 13 - Signature Date Item 14 - Printed Name of Authorized Person

whose signature is provided in Item 12 Item 15 - Title or Position of Authorized Person Item 16 - Telephone Number of Authorized Person



Form 486 – Filing of Form

Submit completed form: Mailing Address:

SLD - Form 486P.O. Box 7026Lawrence, KS 66044-7026

For express delivery services or U.S. Postal Service Return Receipt Requested: SLD - Form 486

c/o Ms. Smith3833 Greenway DriveLawrence, KS 66046Telephone number for receipt purposes: 888-203-8100



Where to Go For Help

On the Web: www.sl.universalservice.org Client Service Bureau: 1-888-203-8100 Via E-mail: [email protected] Via fax: 1-888-276-8736

form 486 step-by-step receipt of service confirmation train-the-trainer workshop september 17-18,...

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