Form 486 StepbyStep Receipt of Service Confirmation

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Form 486 Step-by-StepReceipt of Service
Confirmation

Train-the-Trainer Workshop September 17-18,
2001 Schools Libraries Division, USAC
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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 SLDs receipt of the Form
  486

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Form 486 Receipt of Service Confirmation Form

• 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 Childrens Internet
  Protection Act (CIPA)

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Form 486 Receipt of Service Confirmation Form

• Impact of CIPA Requirements
• Beginning with Funding Year 4, the Childrens
  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

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Form 486 Receipt of Service Confirmation Form

• 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

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Form 486 Receipt of Service Confirmation Form

• 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

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Form 486 Receipt of Service Confirmation Form

• 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

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Form 486 Receipt of Service Confirmation Form

• 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

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Form 486 Receipt of Service Confirmation Form

• 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)

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Form 486 Receipt of Service Confirmation Form

• 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

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Form 486 Receipt of Service Confirmation Form

• Where to File?
• File with Schools and Libraries Division
• Manually, mailing address (P.O. Box)
• SLD - Form 486P.O. Box 7026Lawrence, KS
  66044-7026

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Form 486 Receipt of Service Confirmation Form

• 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

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Form 486 Receipt of Service Confirmation Form

• 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

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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
• Applicants 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.

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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)
• Applicants Form Identifier (from Top of Form,
  page 1)
• Name of Contact Person (from Item 5 below)
• Contact Person Telephone Number (from Item 5
  below)

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Form 486, Block 1Billed 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

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Form 486, Block 1Billed Entity Information

• Item 3 Funding Year
• Provide the Funding Year for which your funds
  were approved, e.g., 07/01/200106/30/2002
• 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

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Form 486, Block 1Billed Entity Information

• 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)

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Form 486, Block 1Billed Entity Information

• 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

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Form 486, Block 2aFUNDING 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

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Form 486, Block 2aFUNDING 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

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Form 486, Block 2bFUNDING 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

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Form 486, Block 2bFUNDING YEARS AFTER FUNDING
YEAR 4 Early Filing Information CIPA Waiver
Request

• 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

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Form 486, Block 2bFUNDING YEARS AFTER FUNDING
YEAR 4 Early Filing Information CIPA Waiver
Request

• 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)

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Form 486, Block 3Service 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)

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Form 486, Block 3Service 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

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Form 486, Block 4Certifications 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.

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Form 486, Block 4Certifications and Signature

• 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

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Form 486, Block 4Certifications and Signature

• 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

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Form 486, Block 4Certifications and Signature

• Item 11 CIPA Certifications
• This item concerns compliance with the
  requirements of the Childrens 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

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Form 486, Block 4Certifications and Signature

• 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

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Form 486, Block 4Certifications and Signature

• 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

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Form 486, Block 4Certifications and Signature

• 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

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Form 486, Block 4Certifications and Signature

• 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

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Form 486, Block 4Certifications and Signature

• 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

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Form 486, Block 4Certifications and Signature

• 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

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

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Where to Go For Help

• On the Web www.sl.universalservice.org
• Client Service Bureau 1-888-203-8100
• Via E-mail question_at_universalservice.org
• Via fax [phone]