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Commission Document Attachment

FCC Form 486
Approval by OMB
Control No. 3060-0853
Estimated time per response: 1.5 hours

Universal Service for Schools and Libraries

Receipt of Service Confirmation and Certification of Compliance with the Children's Internet Protection Act and

Technology Plan Requirements Form

Instructions for Completing the

Schools and Libraries Universal Service

Receipt of Service Confirmation and Certification of Compliance with the Children's Internet Protection Act and

Technology Plan Requirements Form

TABLE OF CONTENTS

NOTICE

Page

1

I.

INTRODUCTION

Page

1

II. IMPACT OF CIPA REQUIREMENTS ON FCC FORM 486

Page

2

III. FILING REQUIREMENTS AND GENERAL INSTRUCTIONS

Page

4

IV. SPECIFIC INSTRUCTIONS

Page

7

FCC NOTICE FOR INDIVIDUALS REQUIRED BY THE PRIVACY ACT AND THE PAPERWORK REDUCTION ACT

Part 54 of the Commission's Rules authorizes the FCC to collect the information on this form. Failure to provide all
requested information will delay the processing of the application or result in the application being returned without action.
Information requested by this form will be available for public inspection. Your response is required to obtain the
requested authorization.
The public reporting for this collection of information is estimated to range from 1.0 to 1.5 hours per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the required data, and
completing and reviewing the collection of information. If you have any comments on this burden estimate, or how we can
improve the collection and reduce the burden it causes you, please write to the Federal Communications Commission,
AMD-PERM, Paperwork Reduction Act Project (3060-0853), Washington, DC 20554. We will also accept your comments
regarding the Paperwork Reduction Act aspects of this collection via the Internet if you send them to PRA@fcc.gov.
PLEASE DO NOT SEND YOUR RESPONSE TO THIS FORM TO THIS ADDRESS.
Remember - You are not required to respond to a collection of information sponsored by the Federal government, and the
government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail
to provide you with this notice. This collection has been assigned an OMB control number of 3060-0853.

THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31,
1974, 5 U.S.C. 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1,
1995, 44 U.S.C. SECTION 3507.

I. INTRODUCTION

The FCC Form 486 Receipt of Service Confirmation and Children's Internet Protection Act and Technology Plan
Certification Form
is used by the Billed Entity who filed an FCC Form 471, Description of Services Ordered and
Certification Form, on behalf of an eligible school, school district, library (outlet/branch, system), or a consortium of those
entities. The FCC Form 486 informs USAC when the Billed Entity and/or the eligible entities that it represents is receiving,
is scheduled to receive, or has received service in the relevant Funding Year from the named service provider(s). Receipt
of a properly completed FCC Form 486 by USAC triggers the process for USAC to receive and process invoices.

OMB Control No. 0360-0853
The FCC Form 486 must be filed to accomplish the following:

To notify USAC of initial service start dates and authorize the payment of invoices from your service provider(s)

To certify that entities are covered by approved technology plans if required by program rules

To certify (starting in Funding Year 2001, which began July 1, 2001) the status of compliance with the Children's
Internet Protection Act (CIPA)
Note: To cancel or reduce a Funding Request, change the Contract Expiration Date reported on the FCC Form 471 or
seek an extension of the deadline for implementation of non-recurring services, please file an FCC Form 500.. Please
refer to the FCC Form 500 instructions for more information.
Throughout these Instructions, the Billed Entity will be referred to as "Billed Entity" or "you." A Billed Entity may be a
school, school district, library (outlet/branch, system), or a consortium of those entities. A Billed Entity may also be a city, a
state, or an entity created solely to participate in this universal service discount mechanism that actually pays the bills for
the service to the service provider. The Billed Entity itself may or may not be eligible for discounts. The same Billed Entity
that filed the FCC Form 471 application should be identified as the Billed Entity for the FCC Form 486. Please note that
consortium leaders generally have a special requirement for Funding Year 2001 and later (see the instructions for Item
11).
You must submit the relevant information on a FCC Form 486 for each Funding Request Number (FRN). Each FRN from
FCC Form 471, Block 5 contains information about one service for which you have requested discounts. You may have
submitted multiple Block 5 requests. The FRN(s) cited on this FCC Form 486 must be based on the FRN(s) cited in the
Funding Commitment Decision Letter(s) (FCDL) issued by USAC.
Universal service support will not be paid to a service provider on an approved funding commitment prior to receipt of the
FCC Form 486. A service provider is not obliged to begin providing discounts to you UNTIL you file a properly completed
FCC Form 486 that is accepted and processed by USAC. We will send a written notification to you and to your service
provider to acknowledge receipt and successful data entry of a FCC Form 486 for each FRN for which the Service
Provider Identification Number (SPIN) is listed. The service provider may invoice USAC for discounts provided pursuant to
an approved FRN after receiving the written notification letter of receipt of FCC Form 486 for the particular FRN and after
the start of the Funding Year.
You may elect EITHER to receive discounts on bills, or to pay bills in full and receive retroactive reimbursement through an
FCC Form 472, Billed Entity Applicant Reimbursement (BEAR) Form. You must choose only ONE method of discounts for
each Funding Request Number (FRN) for the relevant Funding Year. Work with your service provider to verify which form
of discount is available and works best for you.

II. IMPACT OF CIPA REQUIREMENTS ON FCC FORM 486

The Children's Internet Protection Act (CIPA) was signed into law on December 21, 2000. In order to receive discounts for
Internet Access, Internal Connections and Basic Maintenance services under the universal service support mechanism,
school and library authorities must certify that they are enforcing a policy of Internet safety as explained in Section V.
Beginning with Funding Year 2001 (the Funding Year beginning July 1, 2001) schools and libraries applying for Internet
Access, Internal Connections or Basic Maintenance must certify on FCC Form 486 that they are in compliance with the
requirements of CIPA. Schools and libraries applying for Internet Access, Internal Connections or Basic Maintenance for
the first time that have not completed all of the requirements for CIPA must certify that they are undertaking such actions
and will comply with the requirements of CIPA prior to the start of the following funding year. Although CIPA requirements
do not apply to telecommunications services, Billed Entities applying only for telecommunications services must, in
general, still certify on a FCC Form 486 that CIPA requirements do not apply. Note that selecting a telecommunications
carrier as a service provider does not absolve schools and libraries of their obligation to comply with CIPA when they use
that service to obtain Internet service or access to the Internet. There are, however, some services that will not require
CIPA compliance even if selected in the Internet access category if they are used for telecommunications transmission
purposes only. These include telecommunications services, telecommunications, interconnected Voice over Internet
Protocol (VoIP) services, and fiber services. If any other Internet access services such as basic Internet access, web
hosting or e-mail service are included or bundled with the telecommunications services, telecommunications, VoIP or fiber
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services, CIPA compliance is required. Additional information on the requirements of CIPA is posted in the CIPA page on
the USAC website. (For more information, see the Children's Internet Protection Act, as codified at 47 U.S.C. 254(h)
and (l).)

Administrative Authority:

The Administrative Authority for a school or library is the entity that must make the relevant
certification for purposes of CIPA. For a school, the Administrative Authority may be the school, school district, school
board, local educational agency, or other authority with responsibility for administration of the school. For a library, the
Administrative Authority may be the library, library board, or other authority with responsibility for administration of the
library.
If the Administrative Authority is also the Billed Entity, the Administrative Authority certifies on the FCC Form 486. If the
Administrative Authority is not the Billed Entity, the Administrative Authority must complete FCC Form 479, Certification of
Administrative Authority to Billed Entity of Compliance with the Children's Internet Protection Act
, and submit the FCC
Form 479 to the Billed Entity. The Billed Entity then certifies on the FCC Form 486 that it has collected duly completed and
signed FCC Form(s) 479. The Billed Entity does not need to collect FCC Forms 479 when the Billed Entity applies only for
telecommunications services.

Applying for Funds:

For the purpose of CIPA requirements, a school or library that is a recipient of service is considered
to have applied for funds in a Funding Year after an FCC Form 486 is successfully data entered and USAC issues a Form
486 Notification Letter featuring an FRN for Internet Access, Internal Connections or Basic Maintenance.

Determination of Your First Funding Year for Purposes of CIPA:

The first Funding Year after Funding Year 2000 (the
Funding Year beginning July 1, 2000) in which a school or library applies for funds (i.e., in which an FCC Form 486 is
successfully data entered for Internet Access, Internal Connections or Basic Maintenance and USAC issues an FCC Form
486 Notification Letter) is your

First Funding Year

for purposes of CIPA. Once your First Funding Year is established, the
next two funding years will be your second and third funding years for purposes of CIPA. (See "Applying for Funds"
above.) In your first Funding Year, you must be in compliance with CIPA or undertaking actions to comply with CIPA, in
order to receive discounts for Internet Access, Internal Connections or Basic Maintenance services.
Once your First Funding Year is established, the Funding Year immediately following the First Funding Year becomes your

Second Funding Year

for purposes of CIPA. If the school or library applies for funds for Internet Access, Internal
Connections or Basic Maintenance in the Second Funding Year, it must certify that it is in compliance with CIPA unless
state or local procurement rules or regulations or competitive bidding requirements prevent the making of the certification
otherwise required. A school or library so prevented may request a waiver for the Second Funding Year. (See the
instructions for Item 6b.)
Your

Third Funding Year

for purposes of CIPA is the Funding Year immediately following your Second Funding Year. If
the school or library applies for funds for Internet Access, Internal Connections or Basic Maintenance in the Third Funding
Year, it must be in compliance with CIPA.
You must be in compliance with CIPA for any Funding Year thereafter.
The following situations WOULD constitute the Administrative Authority's First Funding Year:

The Billed Entity submits an FCC Form 486 for Internet Access, Internal Connections or Basic Maintenance, the
FCC Form 486 is successfully data entered and USAC issues a Form 486 Notification Letter, but the Billed Entity
cancels all of its FRNs on an FCC Form 500.

The Billed Entity submits an FCC Form 486 for Internet Access, Internal Connections or Basic Maintenance, the
FCC Form 486 is successfully data entered and USAC issues an FCC Form 486 Notification Letter, but the
service provider does not receive a corresponding disbursement.
The following situations WOULD NOT constitute the Administrative Authority's First Funding Year:

The Billed Entity receives a Funding Commitment for Internet Access, Internal Connections or Basic Maintenance,
but takes no further action.

The Billed Entity receives a Funding Commitment for Internet Access, Internal Connections or Basic Maintenance,
submits FCC Form 486, but the FCC Form 486 is not successfully data entered and no FCC Form 486 Notification
Letter is issued.

The Billed Entity applies only for telecommunications services.
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III. FILING REQUIREMENTS AND GENERAL INSTRUCTIONS

A.

Who Must File the FCC 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 FCC Form 471 to which this FCC Form 486 relates, must file the FCC Form 486 with USAC.
Your FCDL from USAC cites your Billed Entity Number, which you must also record in Block 1, Item 2 of this form. If you
received multiple FCDLs approving discounts for the same Billed Entity Number, in general you may choose to complete
one FCC Form 486 encompassing all of them (see "When, Where and How Many Forms 486 to File" below).

B.

When, Where, and How Many FCC Forms 486 to File

When:

You may file a FCC Form 486 no earlier than the receipt of an FCDL from USAC.
The complete FCC Form 486 with certification MUST be received by USAC, submitted online or postmarked no later
than 120 days after the Service Start Date featured on the FCC Form 486 or no later than 120 days after the date of your
FCDL, whichever is later, in order to receive discounts retroactively to the Service Start Date. If the FCC Form 486 is
postmarked later than the deadline, the date 120 days before the FCC Form 486 postmark date will become the start date
for discounted services on those FRNs featured on the FCC Form 486. USAC will not provide discounts for the services
rendered prior to the new start date and will reduce the funding commitment for the relevant FRN as appropriate.
For more information on when to file an FCC Form 486 for recurring or non-recurring services, please see the Specific
Instructions for Block 3, Item 7(E), Funding Year Service Start Date, later in these instructions.
Program rules require that recurring services be delivered during the Funding Year. Funding years begin on July 1 and
end on the following June 30. In general, non-recurring services must be delivered and installed between July 1 of the
relevant Funding Year and September 30 following the June 30 close of that Funding Year. Invoices must be postmarked
no later than 120 days after the last date to receive service or 120 days after the date of the FCC Form 486 Notification
Letter, whichever is later. However, program rules allow certain participants to receive extensions of the deadline for
delivery and/or installation of non-recurring services. Rules also allow for extensions of the invoicing deadlines. In some
cases, these extensions must be requested by the applicant or service provider and approved by USAC. Consult the FCC
Form 500 and accompanying instructions for information about extensions of the deadline for delivery and/or installation of
non-recurring services. Consult the Invoice Extensions page on USAC's website for complete information on extending
invoice deadlines:
Guidance on when to file in certain specific situations is provided below:
1. EARLY FILING: For those FRNs for services where the date of the FCDL and the Service Start Date featured on
the FCC Form 486 are both before July 31 of the Funding Year, you have the option to file FCC Form 486 early --
that is, in advance of services starting -- if certain conditions are met. If the FCC Form 486 is filed in this manner,
it must be received by USAC or postmarked on or before July 31 of the Funding Year.

You may be eligible to file the FCC Form 486 on or before July 31 of the Funding Year if:

you have received your FCDL and

you have confirmed with the named service provider that the services you ordered will start on the Service Start
Date, which must be in July of the Funding Year and

you are able to accurately make all of the relevant certifications in Block 4 in advance of the date of the start of
discounted services.
This option is at the discretion of the Billed Entity; it has the merit of facilitating the provision of discounts on bills as soon
as possible and means that USAC is authorized to begin payments on invoices submitted by your service provider for
services delivered and installed on or after the Service Start Date.
For early filing, complete your FCC Form 486 including the certification(s) in Items 8 and 11 and postmark the FCC
Form 486 on or before July 31 of the Funding Year. Early filers must also check Item 6a.
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2. Filing Multiple FCC Forms 486
If you have FRNs featuring Service Start Dates occurring at different times during the Funding Year, you may decide to file
multiple FCC Forms 486 at different times to ensure that discounts are paid back to the Service Start Dates.
3. Filing an FCC Form 486 for an FRN under Appeal
If USAC has made a positive funding commitment on an FRN, the FCC Form 486 filing deadline described above still
applies to that FRN. You must file the form in a timely manner to avoid an adjustment to your Service Start Date. If USAC
denied funding and funding is granted on appeal, the date of the Revised Funding Commitment Decision Letter (RFCDL),
rather than the date of the FCDL, is used to calculate the filing deadline for the FCC Form 486.
4. Filing an FCC Form 486 for a Split FRN
If a new FRN is created after USAC issues an FCDL (e.g., if an existing FRN is split because a SPIN change request is
approved and both the old and new service providers provided service during the funding year), you must file an FCC
Form 486 for the new FRN. The date of the RFCDL is used to calculate the filing deadline for the FCC Form 486.
5. Use of FCC Form 500 to Adjust Service Start Date
Under certain conditions, you can adjust the Service Start Date previously reported on a FCC Form 486 by filing a FCC
Form 500.
Please refer to the FCC Form 500 instructions for more information.
6. Libraries in Funding Years 2003 and 2004

Beginning with Funding Year 2003,

libraries must be in compliance with CIPA (section 254(h)(6) of the
Communications Act is applicable to libraries) or undertaking actions to comply with CIPA in order to receive
discounts for Internet Access, Internal Connections or Basic Maintenance.

If a library that applied for funds for Internet Access, Internal Connections or Basic Maintenance in Funding Year
2003 applies for funds for Internet Access, Internal Connections or Basic Maintenance in Funding Year 2004, it
must certify that it is in compliance with CIPA unless state or local procurement rules or regulations or competitive
bidding requirements prevent the making of the certification otherwise required. A library so prevented may
request a waiver for Funding Year 2004. (See "Applying for Funds" above and the instructions for Item 6b below.)

If a library has applied for funds for Internet Access, Internal Connections or Basic Maintenance in both Funding
Years 2003 and 2004, it must be in compliance with CIPA in Funding Year 2005 and any Funding Year thereafter.
(See "Applying for Funds" above.)

Libraries that apply for funds for Internet Access, Internal Connections or Basic Maintenance for the first time in
Funding Year 2004 or any subsequent year should follow the procedures in the "Determination of Your First
Funding Year for Purposes of CIPA" above.

Where:

You may complete and submit the FCC Form 486 by using "Apply Online" on the USAC website at http://www.usac.org/sl" title="www.usac.org/sl">www.usac.org/sl. If you
are filing the FCC Form 486 online, you must also complete and submit to USAC the Block 4 Certification with the
signature of the authorized person (whether online or on paper). If you have a User ID and a PIN, you are encouraged to
submit your FCC Form 486 certifications online.
Please submit this form to:

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

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For express delivery services or U.S. Postal Service, Return Receipt Requested, mail this form to:

SLD Forms
ATTN: Form 486
3833 Greenway Drive
Lawrence, KS 66046
(888)203-8100

Note: DO

NOT

FILE THIS OR ANY OTHER UNIVERSAL SERVICE FORM WITH THE FEDERAL COMMUNICATIONS
COMMISSION.

How Many:

Note that only one Funding Year can be featured on an FCC Form 486.
When deciding whether to file a single FCC Form 486 for multiple FRNs or multiple FCC Forms 486 for separate FRNs,
consider the following points:
1. Early filing. It is possible that you will have one or more early FCC Forms 486 and one or more later FCC
Forms 486. See the Block 2 instructions below for more information on early filing.
2. Timing of start dates. Is the Service Start Date the same or varied among the multiple FRNs? If multiple
FRNs have the same or similar start dates for service, then you may file one FCC Form 486 for all of the
FRNs with Service Start Dates that have occurred, or, in the case of early filing, are scheduled to occur. See
"Where, When and How Many Forms 486 to File" above for more information on the relationship of Service
Start Dates to FCC Form 486 filing deadlines.
3. Availability of information. If any of the information required for a particular FRN is missing, submit a separate
FCC Form 486 for the particular FRN in question. In order for your FCC Form 486 to be successfully
processed, complete all components of information. If required information is missing or an invalid entry is
made, your FCC Form 486 may be rejected and returned to you without being accepted and processed and
will be delayed.
4. You must complete a separate FCC Form 486 in the following situations:

if you receive FCDLs featuring more than one Billed Entity Number. (Only one Billed Entity Number may
be featured on an FCC Form 486.)

for Funding Year 2001 and later, if the Item 11a certification applies to certain FRNs and the Item 11b
certification applies to other FRNs. (However, if you file a FCC Form 486 for FRNs for which either Item
11a or Item 11b applies, you may include FRNs for telecommunications services on that FCC Form 486.)

for Funding Year 2002 and later, if you file a waiver of CIPA requirements for a portion of your funded
FRNs (see waiver information under Item 6 below).

Assistance in Completing This Form

There are several sources of assistance to guide you in completing this form. If you complete this form online on our
website, you will be assisted in the process by special step-by-step instructions. Complete program information is also
available by contacting the Schools and Libraries Client Service Bureau via email using Submit a Question on the USAC
website, via fax at 1-888-276-8736 or via phone at 1-888-203-8100.

Compliance

Persons willfully making false statements on this form can be punished by fine or forfeiture, under the
Communications Act, 47 U.S.C. 502, 503(b), or fine or imprisonment under Title 18 of the United States Code,
18 U.S.C. 1001.

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IV. SPECIFIC INSTRUCTIONS

You are encouraged to complete and submit this form online. Alternatively, for paper submissions, you may download a
paper version of the form from the website. If you file paper copies of the form, please type or clearly print in the spaces
provided and attach and label additional pages if needed.
Only one Funding Year can be featured on an FCC Form 486.

Top of Form

The data at the top of FCC Form 486 will help both you and USAC identify each particular FCC Form 486 you file.
"Do Not Write In This Area" - USAC 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:

If you are filing more than one FCC Form 486, please use this space to assign a unique
number or letter of your own devising to facilitate communication with us about THIS particular FCC Form 486. This
Applicant's Form Identifier can be very simple; for example, if you are filing three FCC Forms 486, 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.

FCC Form 486 Application Number:

USAC will assign and insert your FCC Form 486 Application Number. Leave this
item blank.

Top of each page after page 1:

If you are filing this form on paper, please provide the Entity Number (from Item 2,
below), your Applicant's Form Identifier, and name and phone number of the contact person (from Item 5, below) at the top
of each page of the form in the space provided. This will help alleviate problems if the pages become separated.

A.

Block 1: Billed Entity Information

Block 1 of FCC Form 486 asks you for your address and basic identification information, such as your name, address and
contact information. "You" refers to the Billed Entity a school, school district, library (outlet/branch, system), or a
consortium of those entities. A Billed Entity may also be a city, a state, or an entity created solely to participate in this
program, that actually pays the bills for the service to the service provider. The Billed Entity itself may or may not be
eligible for discounts.

Item 1

Provide the name of the Billed Entity from the corresponding FCDL.

Item 2

Provide your Billed Entity Number as it appears on the corresponding FCDL. Please be sure to obtain this
information from your FCDL, as the information may have been corrected during our review of your FCC Form 471
application.

Item 3

Provide the Funding Year for which your funds were approved, e.g., "07/01/2001 06/30/2002." The Funding Year
you supply here must be the same as the Funding Year contained in your FCDL for the corresponding FCC Form 471. Cite
only one funding year in this item.

Item 4

- 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. In addition, please provide your
telephone number with area code and extension and fax number.

Item 5

Provide the name of the person who should be contacted with questions about this form. The Contact Person
must be able to answer questions in a timely manner regarding the information included in this form. If the contact
person's mailing address, telephone number or fax number is different from the information in Item 4, provide that
information here. Also provide the contact person's email address. You MUST check the preferred mode of contact and
provide the contact information for your preferred mode. Wherever possible, USAC will use this mode to contact you.

B.

Block 2: Early Filing Information and CIPA Waiver Request

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Item 6a

To file FCC Form 486 before services start, this item must be checked and the FCC Form 486 must be received
by USAC or postmarked on or before July 31 of the Funding Year. In order to file FCC Form 486 before services start, you
must meet the requirements for "EARLY FILING" explained above. (See "When, Where and How Many FCC Forms 486
to File) If you are submitting FCC Form 486 after services have started, do not check this box.

Item 6b

If you are a Billed Entity who is also the Administrative Authority for the purpose of CIPA, you must check Item
6b if you need to request a waiver from CIPA requirements in your Second Funding Year (see the explanation in "IMPACT
OF CIPA REQUIREMENTS ON FCC FORM 486" above).
In Item 6b you may provide notification that, as of the date of the start of discounted services, you are unable to make the
certification in Item 11a because your state or local procurement rules or regulations or competitive bidding requirements
prevent you from making that certification. You also certify that the schools or libraries represented in the FRN(s) on this
FCC Form 486 will be brought into compliance with the CIPA requirements before the start of the Third Funding Year in
which they apply for discounts. If the Billed Entity is not the Administrative Authority, Item 6b should NOT be checked.
For example, if in Funding Year 2001 you certify that you are undertaking such actions necessary to be in compliance with
the requirements of CIPA for Funding Year 2002, then in order to obtain discounts in Funding Year 2002, you must be in
compliance with the requirements of CIPA prior to the start of services in that Funding Year unless you obtain a waiver as
a result of procurement/competitive bidding constraints. In this example, if you obtain a waiver in Funding Year 2002, you
must be in compliance with the requirements of CIPA prior to the start of Funding Year 2003.
In certain situations, a Billed Entity could have some FRNs for which waivers can be requested and other FRNs for which
waivers are not requested. An FCC Form 486 with Item (6b) checked must only feature FRNs for which waivers are being
requested.

NOTE FOR LIBRARIES

If you are a Billed Entity who is also the Administrative Authority for the library(ies) represented
on this FCC Form 486, you must check Item 6b if you need to request a waiver from CIPA requirements for Funding Year
2004.
In Item 6b you may provide notification that, as of the date of the start of discounted services, you are unable to make the
certification in Item 11a because your state or local procurement rules or regulations or competitive bidding requirements
prevent you from making that certification. You also certify that the libraries represented in the FRN(s) on this FCC Form
486 will be brought into compliance with the CIPA requirements before the start of Funding Year 2005. If the Billed Entity
is not the Administrative Authority, Item 6b should NOT be checked.

C.

Block 3: Service Information

Block 3 of FCC Form 486 asks you to provide the FCC Form 471 Application Number, the FCC Form 471 Funding
Request Number, the SPIN, the Service Provider Name, and the Funding Year Service Start Date.

Item 7

Information to complete Columns (A) (D) will be contained in your FCDL. If you file the FCC Form 486 online,
the entries for Columns (A), (C), and (D) will be automatically populated after you complete the entry of an FRN in Column
(B).
Columns (A), (B), (C), and (D)
You must provide the following information for columns (A), (B), (C), and (D). All of this information should be obtained
from the FCDL issued to each FCC Form 471 Billed Entity approved for funding.
(A) FCC Form 471 Application Number;
(B) Funding Request Number (FRN) for the services to be provided;
(C) Service Provider Identification Number (SPIN),
(D) Service Provider Name
Column (E)
Funding Year Service Start Date: The date on which the service for each FRN started, or, in certain circumstances, is
scheduled to start. This date cannot be earlier than the first day of the Funding Year (July 1). Provide this date in month,
day and four-digit year (mm/dd/yyyy) format.
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Funding Year Service Start Date Definition:
For recurring services (for example, Telecommunications Services, Internet Access or ongoing Basic Maintenance), the
Funding Year Service Start Date may be:

the date that service has started and billing begins;

the date that billing has been established for your account;

the beginning date of the billing period covered by your first bill for the service in this Funding Year.
In no instance can this date be earlier than July 1 of the relevant Funding Year.
For non-recurring services/products installation (for example, installation of Telecommunications Services or Internet
Access or purchase of eligible Internal Connections), the Funding Year Service Start Date may be:

July 1 of the relevant Funding Year for contracts that require a prepayment before the start of the Funding
Year. These prepayments may be requested by the service provider at the time that the contract is signed or
before work begins;

the date that you order the product/service;

the date that the service provider ships the product;

the date that the installation/construction of work begins. (See the Advance Installation page on USAC's
website.)
In no instance can the reported date be earlier than July 1 of the relevant Funding Year.
Please remember that in order to obtain discounted services from your service provider for a particular service or group of
services for which USAC approved discounts, you MUST file an FCC Form 486 with Column (E) completed to indicate the
Funding Year Service Start Date.

D.

Block 4: Certification

Item 8

- Check this box to certify that, if required by program rules, the schools and libraries listed on this FCC Form 486
are covered by technology plans that have been approved by a state or other authorized body (a USAC-certified
technology plan approver) prior to the commencement of service and that cover all 12 months of the funding year. If
applicable, provide the name(s) of the organization(s) that are the USAC-certified technology plan approver(s) that
approved a technology plan for any eligible entity that is receiving services covered under this FCC Form 486. If EVERY
FRN listed in the FCC Form 486 is for services that do not require a technology plan, enter "NONE." If a technology plan
is required, each entity receiving these services under the FRNs listed on this FCC Form 486 MUST be included under a
technology plan that has been approved by a reviewing organization, and that organization MUST have been certified by
USAC for the Funding Year referenced on the FCC Form 486. If you have any questions about technology plan review,
please check the Technology Planning pages on USAC's website.

Item 9

- Certify that the services listed on this FCC Form 486 have been, are planned to be, or are being provided to the
eligible entities identified in the FCC Form 471 application(s) cited in this FCC Form 486. Further certify there are signed
contracts covering all of the services listed except for those services provided under tariff or on a month-to-month basis.
Item 9 also requires the individual signing on behalf of the Billed Entity to certify that he or she is authorized to submit the
information contained in the FCC Form 486 on behalf of the Billed Entity. The individual signing on behalf of the Billed
Entity must certify that the information contained in FCC Form 486 is true to the best of his or her knowledge, information
and belief.

Persons knowingly making false statements on this form can be punished by fine, forfeiture, or imprisonment
under federal law.

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Item 10

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 services receive an
appropriate share of benefits from those services. Certify that you recognize that you may be audited pursuant to this
application and will retain for five years (or whatever retention period is required by the rules in effect at the time of your
certification) any and all records, including FCC Forms 479 where required, that you rely upon to complete this form and, if
audited, will make such records available.

Item 11

This item concerns compliance with the requirements of the Children's Internet Protection Act (CIPA), as
codified at 47 U.S.C. 254(h) and (l), and the implementing rules as codified at 47 C.F.R. 54.520. If this FCC Form 486
pertains to a Funding Year prior to Funding Year 2001 (Funding Years beginning July 1, 2000 or earlier), skip Item 11 and
go to Item 12. Additional information on the requirements of CIPA is posted in the CIPA document on the USAC website.
If this FCC Form 486 pertains to Funding Year 2001 (the Funding Year beginning July 1, 2001) or later, the recipient(s) of
service represented in the FRN(s) on this FCC Form 486 must certify the status of compliance with CIPA. If you as the
Billed Entity are the Administrative Authority, you will indicate the status of compliance on the FCC Form 486. If you as the
Billed Entity represent one or more Administrative Authorities (e.g., a consortium leader), then in most cases you must
collect completed and signed FCC Forms 479, Certification by Administrative Authority to Billed Entity of Compliance with
the Children's Internet Protection Act
, from those Administrative Authorities who are the recipients of service so that you as
the Billed Entity can make the proper certification(s) on FCC Form 486. (You do not have to collect FCC Forms 479 if you
were funded only for telecommunications services.)
For Funding Year 2001 and later, Item 11 must be filled in.
General Instructions for Item 11:
1. A Billed Entity who is a recipient of service must check Item 11a or 11b or 11c. If the Billed Entity is not a recipient
of service, skip to Item 11d.
2. A Billed Entity who represents one or more Administrative Authorities must check Item 11d or 11e. (See "Special
Notes for Billed Entities Who Represent One or More Administrative Authorities" below.)
3. FOR FUNDING YEARS AFTER FUNDING YEAR 2001, a Billed Entity who must collect FCC Forms 479 and who
checks Item 11d must check Item 11f or 11g. (See "Special Notes for Billed Entities Who Represent One or More
Administrative Authorities" below.)
4. IF THIS FORM PERTAINS TO A FUNDING YEAR PRIOR TO FUNDING YEAR 2001 (THE FUNDING YEAR
BEGINNING JULY 1, 2001), SKIP TO ITEM 12.
Special Notes for Billed Entities Who Represent One or More Administrative Authorities:
The Administrative Authority must make a certification for purposes of CIPA. (See "IMPACT OF CIPA REQUIREMENTS
ON FCC FORM 486" above for the definition of Administrative Authority.) However, in the following cases, the Billed Entity
is not the Administrative Authority and therefore must collect FCC Forms 479 from the Administrative Authority(ies):

the Billed Entity is the lead member of a consortium but is not the Administrative Authority for all of the members
of the consortium.

the Billed Entity is a state or local government entity or other entity who acts as the Billed Entity for one or more
schools or libraries represented on its FCC Form 486 but who is not the Administrative Authority for those schools
or libraries.

the Billed Entity is the Administrative Authority for one or more schools or libraries (perhaps including itself) on its
FCC Form 486 but is not the Administrative Authority for other schools or libraries on its FCC Form 486.
Following are descriptions of specific situations these Billed Entities may encounter:
A Billed Entity who is not an Administrative Authority must collect FCC Forms 479 from the Administrative Authority of
any school or library represented on its FCC Form 486 unless it was funded only for telecommunications services.
Typically, such Billed Entities would be consortium leaders. In the case of a Billed Entity who is the Administrative
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Authority for some schools and/or libraries but not for others, that Billed Entity must duly complete, sign and keep an
FCC Form 479 for each school or library for which it is the Administrative Authority unless it applied only for
telecommunications services.
A Billed Entity who is the Administrative Authority and who also represents one or more other Administrative
Authorities must make one certification in Item 11a or Item 11b or Item 11c as well as one certification in Item 11d or
Item 11e.
For Funding Years after Funding Year 2001, a Billed Entity who checks Item 11d must also check Item 11f or Item
11g.
A Billed Entity who checks Item 11e is certifying that the only services for which the Billed Entity has been approved for
discounts on behalf of eligible members of the consortium are telecommunications services. If some of the eligible
recipients have applied for Internet Access, Internal Connections or Basic Maintenance outside of the Billed Entity's
application(s), it is the responsibility of those entities to make the appropriate certifications for those services on
separate FCC Form(s) 486.
If two Billed Entities in a state are both state-level organizations (such as a State Department of Education and a State
Information Network) and both are required to collect FCC Forms 479 from their eligible recipients of services (such as
all schools and school districts or all library outlets and libraries in the state), it is not necessary for both organizations
to duplicate the collection of FCC Forms 479. One state-level Billed Entity can assume the responsibility for collecting
the FCC Forms 479 and share the information with the other state-level Billed Entity. The second state-level Billed
Entity can then check Item 11d with the understanding that "I have duly collected completed and signed FCC Forms
479" means only that the second state-level Billed Entity has evidence that the collection was accomplished.
However, the second state-level Billed Entity must verify that all of its eligible members requesting discounts are
represented in the information collected by the other state-level Billed Entity.
In order to accurately make the relevant certification(s) on the FCC Form 486, the Billed Entity who represents one or
more Administrative Authorities must receive FCC Forms 479 from the appropriate Administrative Entities before filing
FCC Form 486.
Specific Instructions for Item 11
FOR A BILLED ENTITY WHO IS THE ADMINISTRATIVE AUTHORITY:
Check the one box in Items 11a through 11c that describes the status of compliance with CIPA.
Internet Safety Policy. Schools and libraries receiving universal service discounts are required to adopt and enforce an
Internet safety policy that includes a technology protection measure that protects against access by adults and minors to
visual depictions that are obscene, child pornography, or -- with respect to use of computers with Internet access by
minors -- harmful to minors.
The Internet safety policy must address all of the following issues:

Access by minors to inappropriate matter on the Internet and World Wide Web

The safety and security of minors when using electronic mail, chat rooms, and other forms of direct electronic
communications

Unauthorized access including "hacking" and other unlawful activities by minors online

Unauthorized disclosure, use, and dissemination of personal information regarding minors

Measures designed to restrict minors' access to materials harmful to minors
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For schools, the Internet safety policy must also include monitoring the online activities of minors. Beginning with Funding
Year 2012, when schools certify their compliance with CIPA, they are also certifying that their Internet safety policies have
been updated to provide for educating minors about appropriate online behavior, including interacting with other individuals
on social networking websites and in chat rooms and cyberbullying awareness and response.
Technology Protection Measure. A technology protection measure is a specific technology that blocks or filters Internet
access. The school or library must enforce the operation of the technology protection measure during the use of its
computers with Internet access, although an administrator, supervisor, or other person authorized by the authority with
responsibility for administration of the school or library may disable the technology protection measure during use by an
adult to enable access for bona fide research or other lawful purpose.
Public Notice and Hearing or Meeting. The authority with responsibility for administration of the school or library must
provide reasonable public notice and hold at least one public hearing or meeting to address the proposed technology
protection measure and Internet safety policy. Unless required by local or state rules, an additional public notice and a
hearing or meeting is not necessary for amendments to Internet safety policies.

Item 11a

Check here if you certify that the recipient(s) of service represented in the FRN(s) on this FCC Form 486
has (have) complied with the requirements of CIPA. Do not check Item 11a if you check Item 11b.

Item 11b

Check here if you certify that the recipient(s) of service represented in the FRN(s) on this FCC Form 486 is
(are) undertaking such actions, including any necessary procurement procedures, to comply with the requirements of
CIPA for the next Funding Year, but has (have) not completed all requirements of CIPA for this Funding Year. Do not
check Item 11b if you check Item 11a.

Item 11c

Check here if you certify that CIPA does not apply because the recipient(s) of service represented in the
FRN(s) on this FCC Form 486 is (are) receiving discount services only for telecommunications services. (Note: You
may also check here if CIPA does not apply because the services requested are being used for telecommunications
transmission purposes only. This may include telecommunications, interconnected Voice over Internet Protocol (VoIP)
services, and fiber services. If any other Internet access services such as basic Internet access, web hosting or e-mail
service are included or bundled with telecommunications services, telecommunications, VoIP or fiber services, CIPA
compliance is required).
FOR A BILLED ENTITY WHO REPRESENTS ONE OR MORE ADMINISTRATIVE AUTHORITIES:
A Billed Entity who represents one or more Administrative Authorities must make the same certification(s) below as a
Billed Entity who is the lead member of a consortium. If the Billed Entity represents one or more Administrative Authorities,
read "consortium" and "eligible members of the consortium" to mean "the Administrative Authorities I represent."
Check the box(es) in Item(s) 11d through 11g that pertain to your situation:

Item 11d

Check here 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 FCC Forms 479. For Funding Years after Funding Year
2001, a Billed Entity who checks Item 11d must also check Item 11f or 11g. (FCC FORMS 479 ARE NOT
SUBMITTED TO USAC OR TO THE FCC. THEY ARE TO BE COLLECTED AND RETAINED BY THE BILLED
ENTITY. This form is available in the Forms section of the USAC website or may be obtained by contacting USAC's
Client Service Bureau.)

Item 11e

Check here 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 under the universal service support
mechanism are telecommunications services, and therefore the requirements of CIPA do not apply. (Note: You may
also check here if CIPA does not apply because the services requested are being used for telecommunications
transmission purposes only. This may include telecommunications, interconnected Voice over Internet Protocol (VoIP)
services, and fiber services. If any other Internet access services such as basic Internet access, web hosting or e-mail
service are included or bundled with telecommunications services, telecommunications, VoIP or fiber services, CIPA
compliance is required).

Item 11f

For Funding Years after Funding Year 2001: Check here if you certify, as the Billed Entity for the
consortium or for the Administrative Authorities you represent, that some or all of the entities who filed FCC Form 479
are seeking a CIPA Waiver by checking FCC Form 479 Item 6d. Do not check Item 11f if you check Item 11g.
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Item 11g

For Funding Years after Funding Year 2001: Check here if you certify, as the Billed Entity for the
consortium or for the Administrative Authorities you represent, that none of the entities who filed FCC Form 479 is
seeking a CIPA Waiver by checking FCC Form 479 Item 6d. Do not check Item 11g if you check Item 11f.
This certification language contained in the FCC Form 486 is not intended to fully set forth or explain all the requirements
of CIPA.

Item 12

requires the signature of the authorized person.

Item 13

Provide the date the FCC Form 486 was signed. This date must include the month, day and year.

Item 14 -

Print the name of the authorized person whose signature is provided in Item 12.

Item 15 -

Provide the title or position of the authorized person whose signature is provided in Item 12.

Items 16(a)-(e) -

Provide the street address, telephone number with area code, fax number, email address and name of
the employer of the authorized person whose signature is provided in Item 12.

Submit completed FCC Forms 486 by mail to:

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

For express delivery services or U.S. Postal Service, Return Receipt Requested, send FCC Forms 486 to:

SLD Forms
ATTN: SLD Form 486
3833 Greenway Drive
Lawrence, KS 66046
888-203-8100

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