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FCC Form 471 Instructions

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Released: April 29, 2014
OMB 3060-0806

FCC Form 471


Approval by OMB


3060-0806

Schools and Libraries Universal Service

Services Ordered and Certification Form


Estimated Average Burden Hours Per Response: 4 hours

Instructions for Completing the

Schools and Libraries Universal Service

Services Ordered and Certification Form (FCC Form 471)


CONTENTS


Key Information

page 1

Notice

page 2

I.

Introduction

page 3

II.

General Instructions

page 3

III.

Window Filing Requirements

page 6

IV.

Specific Instructions

page 7




KEY INFO

RMATION


• Filing your Form 471 online speeds the processing of your form and reduces errors.
• If you have a PIN, you can certify your Form 471 online as well. USAC issues a PIN to
the authorized person the first time an entity submits a paper form or certification
(Form 470, 471, or 486) featuring that authorized person.
• File requests for Priority 1 and Priority 2 services on separate Forms 471. (See “

When,

Where, and How Many Forms 471 to File

.”)
• Review the “WINDOW FILING REQUIREMENTS” to make sure your form and
attachment(s) are timely filed.
• Note the detailed information provided in the specific instructions for Item 25.
• Remember that the Form 471 application filing window for the funding year closes at
11:59 PM ET on the last day of the filing window. It is your responsibility to check the
SLD web site or contact the SLD Client Service Bureau (CSB) to get the announcement
of the filing window dates. See the “

In-Window Filing Requirements for Forms 471
Submitted Either on Paper or Online

.

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NOTICE


Section 54.504 of the Federal Communications Commission’s (FCC’s or Commission’s) rules requires
all schools and libraries ordering services that are eligible for universal service discounts to file this
Services Ordered and Certification Form (FCC Form 471) with the Schools and Libraries Division (SLD)
of the Universal Service Administrative Company (USAC). See 47 C.F.R. § 54.504. The collection of
information stems from the Commission's authority under Section 254 of the Communications Act of
1934, as amended, 47 U.S.C. § 254. The data collected in Form 471 will be used to ensure that schools
and libraries are receiving the appropriate discounts, complying with the eligibility requirements in 47
C.F.R. § 54.501, and taking steps required by 47 C.F.R. § 54.504 that are necessary to use the discounted
services effectively. All schools and libraries ordering services eligible for universal service discounts
must file this form, individually or as part of a consortium.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number.

The FCC is authorized under the Communications Act of 1934, as amended, to collect the information
we request in this form. We will use the information you provide to determine whether approving this
application is in the public interest. If we believe there may be a violation or potential violation of any
applicable statute, regulation, rule or order, your application may be referred to the Federal, state, or local
agency responsible for investigating, prosecuting, enforcing, or implementing the statute, rule, regulation,
or order. In certain cases, the information in your application may be disclosed to the Department of
Justice or a court or adjudicative body when (a) the FCC; or (b) any employee of the FCC; or (c) the
United States Government, is a party of a proceeding before the body or has an interest in the proceeding.

If you owe a past due debt to the Federal government, the taxpayer identification number and other
information you provide may also be disclosed to the Department of the Treasury Financial Management
Service, other Federal agencies and/or your employer to offset your salary, IRS tax refund, or other
payments to collect that debt. The FCC may also provide this information to these agencies through the
matching of computer records when authorized. In addition, consistent with the Communications Act of
1934, FCC regulations and orders, the Freedom of Information Act, 5 U.S.C. § 552, or other applicable
law, information provided in or submitted with this form or in response to subsequent inquiries may be
disclosed to the public.

If you do not provide the information requested on this form, the processing of your application may be
delayed or your application may be returned to you without action.

The foregoing Notice is required by the Paperwork Reduction Act of 1995, Pub. L. No. 104-13, 44
U.S.C. § 3501, et seq.

Public reporting burden for this collection of information is estimated to average four hours per response,
including the time for reviewing instructions; searching existing data sources; gathering and maintaining
the data needed; completing; and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing
the reporting burden, to the Federal Communications Commission, Performance Evaluation and Records
Management, 445 12th Street, SW., Washington, D.C. 20554.


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I. INTRODUCTION


On May 7, 1997, the FCC adopted rules providing discounts on telecommunications services, Internet
access, internal connections, and basic maintenance of internal connections for all eligible schools and
libraries. Section 54.504 of the FCC’s rules require all eligible schools and libraries ordering services
under this discount mechanism to certify their eligibility to receive discounts. 47 C.F.R. § 54.504.
Section 54.504 of the FCC’s rules directs schools and libraries to submit this information on the Form
471.

II. GENERAL INSTRUCTIONS

A.

Who Must File


Form 471 must be filed to request discounts on eligible services for eligible schools, libraries, and
consortia of those entities. Form 471 must be filed AFTER a Form 470, which must be posted on the
SLD section of the USAC web site for at least 28 days before the Form 471 is filed. The 28-day waiting
period begins after the Form 470 is posted on the SLD web site, www.usac.org/sl, or after an RFP (if
applicable) is made publicly available, whichever is later. This 28-day waiting period must occur before
you may execute any contracts for contracted services, as applicable; before you select your service
provider for tariffed or month-to-month services; and before you submit your completed Form 471. It is
possible that a Form 470 posted in a prior funding year may be used where such a form resulted in a
multi-year contract. (See Form 470 Instructions.)

EACH BILLED ENTITY MUST FILE A FORM 471 APPLICATION.

Thus, even if several billed
entities together filed a single Form 470, each billed entity must file a separate Form 471.

IMPORTANT NOTE:

An entity is considered a “billed entity” if it is responsible for making payments
directly to a service provider. An entity that receives a bill, but does not make payments to the service
provider on that bill, is not a billed entity.

A billed entity may or may not itself qualify for discounts
under the universal service support program for schools and libraries.

Eligibility of schools


For purposes of the schools and libraries universal service support program, schools must meet the
statutory definition of elementary and secondary schools found in the No Child Left Behind Act of 2001,
20 U.S.C. § 7801(18) and (38). An elementary school is a non-profit institutional day or residential
school, including a public elementary charter school that provides elementary education, as determined
under state law. 47 C.F.R. § 54.500 and 20 U.S.C. § 7801(18). A secondary school is a non-profit
institutional day or residential school, including a public secondary charter school, that provides
secondary education, as determined under state law, except that such term does not include any education
beyond grade 12. See 47 C.F.R. § 54.500; 20 U.S.C. § 7801(38). In addition, schools operating as for-
profit businesses or who have endowments exceeding $50 million are not eligible.

Eligibility of libraries and library consortia


Libraries must meet the statutory definition of library or library consortium found in the Library Services
and Technology Act, 20 U.S.C. § 9121 et seq. (1996) (LSTA), and must be eligible for assistance from a
state library administrative agency under that Act. A library includes: “(1) a public library; (2) a public
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OMB 3060-0806
elementary school or secondary school library; (3) an academic library; (4) a research library, which for
the purposes of this definition means a library that: (i) makes publicly available library services and
materials suitable for scholarly research and not otherwise available to the public; and (ii) is not an
integral part of an institution of higher education; and (5) a private library, but only if the state in which
such private library is located determines that the library should be considered a library for purposes of
this definition.” See 47 C.F.R. § 54.500. A library's eligibility for universal service funding also
depends on its funding as an independent entity.

Only libraries whose budgets are completely
separate from any schools’ (including, but not limited to, elementary and secondary schools,
colleges, and universities) shall be eligible to receive discounted services under the universal service
support mechanism.

See 47 C.F.R. § 54.501(c)(2). For example, an elementary school library would
only be eligible to receive discounted services if its budget were completely separate from the elementary
school. If its budget were not completely separate from the elementary school, the elementary school
library would not be eligible for support independent from the school with which it is associated.

A library consortium is “any local, statewide, regional, or interstate cooperative association of libraries
that provides for the systematic and effective coordination of the resources of schools, public, academic,
and special libraries and information centers, for improving services to the clientele of such libraries.”
47 C.F.R. § 54.500(c).

Libraries operating as for-profit businesses shall not be eligible for discounts. 47 C.F.R. § 54.501(c)(3).



B.

When, Where, and How Many Forms 471 to File


When:

A Form 470 must be posted for at least 28 days and a contract must be in place for all services, except
non-contracted tariffed or month-to-month services, before submitting a completed Form 471 to the SLD.

The Form 470 Receipt Notification Letter will expressly identify the EARLIEST date — the Allowable
Vendor Selection/Contract Date — on which you may choose a service provider and, if applicable,
execute a contract, and sign and submit a Form 471. The Allowable Vendor Selection/Contract Date will
also be indicated on the Form 470 posted in the SLD section of the USAC web site.

The earliest date that a Form 471 and its required attachments can be filed for a particular funding year
will be the date established by the SLD as the opening of the Form 471 application filing “window.” The
Form 471 application filing window is the period during which applications will be considered as having
arrived simultaneously. All Forms 471, including certifications and Item 21 attachments, received or
postmarked by the close of the application filing window are considered as if they had arrived on the
same day, and have priority over those postmarked after the closing date of the window. It is your
responsibility to check the SLD section of the USAC web site, www.usac.org/sl, or contact CSB to
obtain the filing window dates.

Where:

The Form 471 may be filed either online or on paper. No Forms 471 will be accepted if sent to the SLD
via e-mail or fax. The Item 21 description of service(s), an in-window filing requirement, may be
submitted online or via e-mail, fax or mail.
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If You Are Filing Online:

You may complete and submit the Form 471 by filing the form online at
the SLD section of the USAC web site www.usac.org/sl. If filing your Form 471 online, you must
also complete and submit to the SLD the documents listed below in order to successfully complete
the submission of your Form 471 application. See WINDOW FILING REQUIREMENTS below for
more information.

• The Block 6 Certification with the signature of the authorized person (whether online or on
paper) is an in-window filing requirement.
• You may qualify to submit your Form 471 certifications online using a PIN. When you
submit your certifications online, you will receive a confirmation so that you can be assured
that your submission has met any filing deadlines. Check the SLD section of the USAC web
site for information about obtaining a PIN.
• The Item 21 description(s) of services submitted online or via e-mail, fax or mail is an in-
window filing requirement and is required before applications can be reviewed.

If You Are Filing on Paper:

You may complete and submit the Form 471 by filing a paper copy of
the completed form, including the completed and signed Block 6 Certifications and any
attachment(s), with the SLD. The signed Form 471 and the Item 21 attachment must be filed with
the SLD at the address listed at the bottom of the form: SLD-Form 471, P.O. Box 7026,
Lawrence, Kansas 66044-7026
. For express delivery or U.S. Postal Service Return Receipt, send
to:

SLD-Forms 471, ATTN: SLD Form 471, 3833 Greenway Drive, Lawrence, Kansas 66046

,
phone 1-888-203-8100. DO NOT FILE THIS OR ANY OTHER UNIVERSAL SERVICE FORM
WITH THE FEDERAL COMMUNICATIONS COMMISSION.

How Many:

You may file more than one Form 471. For example, you may file one Form 471 for Internal
Connections, one for Internet Access, and one for Telecommunications Services. As the billed entity for
services requested on one or more Forms 470, you may combine services requested on multiple Forms
470 into one Form 471, or you may file a corresponding Form 471 for each Form 470 filed. Please refer
to the detailed instructions for more information about these procedures.

NOTE: Applicants who are applying for both Priority 1 (Telecommunications Services or Internet
Access) and Priority 2 (Internal Connections and Basic Maintenance of Internal Connections)
services are strongly encouraged to file these requests on separate Forms 471 — that is, to file one
or more Forms 471 for their Priority 1 requests and one or more Forms 471 for their Priority 2
requests. This separation will allow the SLD to process Priority 1 requests and communicate
decisions on funding commitments for those requests more quickly. Because there is often
uncertainty about the funding threshold for Internal Connections, applicants who combine
funding requests for Priority 1 and Priority 2 services on a single Form 471 risk delaying the
notification process for Priority 1 funding decisions. If there are questions about whether the
service provider selection process was conducted in accordance with FCC rules, decisions on both
Priority 1 and Priority 2 requests may be delayed while that process is reviewed.




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C. Assistance in Completing This Form


There are several sources of assistance to guide you in completing this form. If you complete this form
online at the SLD section of the USAC web site at www.usac.org/sl, you will be assisted in the process
by special step-by-step online instructions. Whether you file online or on paper, you are urged to consult
the Reference Area of the SLD section of the USAC web site for guidance in completing this form.
http://www.usac.org/sl/tools/reference-area.aspx Complete program information is also available by
contacting CSB via e-mail using the “Submit a Question” link on the SLD section of the USAC web site,
via fax at 1-888-276-8736, or via toll-free telephone at 1-888-203-8100.


D.

Compliance


Schools and libraries, or consortia acting on behalf of schools and libraries, failing to file the Services
Ordered and Certification Form (Form 471) will not be eligible to receive universal service discounts.
Schools and libraries filing false information are subject to fines under Section 502 of the
Communications Act of 1934, 47 U.S.C. §§ 502, 503(b), or penalties for false statements under Title 18
of the United States Code, 18 U.S.C. § 1001. Under FCC rules, 47 C.F.R. § 54.516(a)(2), you are
required to retain the worksheets and other records used to compile these forms for at least five years
after the last day of service delivered, or whatever retention period is required by the rules in effect at the
time of certification. This includes all documentation showing that you have complied with all
applicable competitive bidding requirements, including copies of competing bids and documentation of
the bid evaluation process and bid criteria used. Thus, if you represent multiple entities, collect data
from those entities, or use that data, you must retain that information for at least five years, or whatever
retention period is required by the rules in effect at the time of certification. If you are audited, you must
be able to make the worksheets and other records used to compile these forms available to the auditor
and/or the SLD, and you must be able to demonstrate to the auditor and/or the SLD how the entries in its
application were derived.

III.

WINDOW FILING REQUIREMENTS


In-Window Filing Requirements for Forms 471 Submitted Either on Paper or Online:

Application Materials:

All materials associated with the Form 471 must be received by 11:59 p.m. ET
on or before the last day of the Form 471 application filing window, if filed online, or postmarked on or
before the last day of the Form 471 application filing window, if filed on paper, in order for the request to
receive consideration as inside the window. It is your responsibility to check the SLD section of the
USAC web site or contact CSB to obtain the announcement of the filing window dates.

The required materials are:

• The Form 471 itself (whether online or on paper)
• The Item 21 attachment (whether submitted online or via e-mail, fax or mail)
• The Block 6 certification pages of the Form 471 with the signature of the authorized person
(whether online or on paper)

Item 21 Attachment Labeling:

Label your attachment as “Item 21 Attachment,” and include the
application number of the Form 471 it supports, or the Applicant Form Identifier if you file on paper. Be
sure to label the attachment to correspond with each Block 5, Item 21 of your application. Send your
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Item 21 Attachment to the SLD online or via e-mail, fax or mail. (See “Item 21 Attachments For Form
471” posted in the Reference Area of the SLD section of the USAC web site for more information.)

Form 471 Application Filing Window Deadline:

It is your responsibility to check the SLD section of
the USAC web site or contact CSB to obtain the filing window dates. Failure to file the Form 471
application materials by the deadline will place the entire application outside the window, and your
funding will be jeopardized.

IV. SPECIFIC INSTRUCTIONS


You are encouraged to complete and submit this form online at www.usac.org/sl. It will be available on
the SLD section of the USAC web site when the Form 471 application filing window opens along with
instructions for filing online. Alternatively, for paper submissions, you may download a paper version of
the form from the web site. If you file paper copies of the application, please type or clearly print in the
spaces provided and attach additional pages if needed.

Do not staple forms or attachments submitted on paper.

A. Top of Form


The data at the top of Form 471 will help both you and the SLD identify each particular Form 471 you
file.

“Do Not Write In This Area” - The SLD uses this space to apply a bar code to your form upon receipt,
so that we can properly track and archive your form.

Applicant’s Form Identifier

- If you are filing more than one Form 471, please use this space to assign
a unique number or letter of your own devising to facilitate communication with us about THIS particular
Form 471. This Applicant’s Form Identifier can be very simple; for example, if you are filing three
Forms 471, you might label them “A,” “B,” and “C.” The Applicant’s Form Identifier can also be
descriptive, such as “Internet.” Choose identifiers that suit your own record keeping needs.

Form 471 Application Number

- The SLD will assign and insert your Form 471 Application Number.
Leave this item blank.

Top of each page after page 1:

If you are filing this application on paper, please provide the Entity
Number (from Item 3a, below), your Applicant’s Form Identifier, and the name and phone number of the
contact person (from Item 6, below) at the top of each page of the application in the space provided. This
will help alleviate problems caused if the pages of an application become separated.

B.

Block 1: Billed Entity Information


Block 1 of Form 471 asks you for your address and other contact information. “You” refers throughout
this form to the billed entity – the party actually paying bills for the eligible schools and libraries listed in
this application form.

Item 1

Provide the name of the billed entity. As the billed entity, you may be an individual school, a
school district that is the billed entity for its schools, a library (outlet/branch, system), or a consortium of
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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, provided that the entity actually pays the bills for the service to
the service provider.

The billed entity itself does not have to be eligible for discounts.


Item 2

Funding years begin on July 1 and end on the following June 30. For example, Funding Year
2014 runs from July 1, 2014 to June 30, 2015. Provide the funding year for which you are applying for
funds by filling in the appropriate year in the blank provided (e.g., 2014).

Items 3a-3b

Your Entity Number and FCC Registration Number are unique numbers assigned to your
organization or institution as a means of identifying you every time you file an application or otherwise
communicate with us. If you have applied for universal service funds in previous years, or have been
identified in an application filed on your behalf, you have already been assigned these numbers. If you
do not have a record of your Entity Number or FCC Registration Number, or if you have never been
assigned such a number, please contact CSB. (See “Assistance in Completing This Form” above.)

Items 4a-4c

Provide your full mailing address, whether a street address, Post Office Box number, or
route number. In addition, please provide your telephone number with area code and extension and your
fax number.

Item 5a –

Check the one box that best describes the type of application you are filing. If you are filing as
an individual school, you should check the first box. If you are filing as a school district or local
education agency (LEA), you should check the second box. If you are filing as a library (outlet/branch,
system, or library consortium as defined under LSTA), you should check the third box. If you are filing
as a consortium, you should check the fourth box. (You may be a consortium of schools, libraries, or
some combination of the above, which may include eligible and ineligible entities.) If you check the fifth
box, you must also check one or more of the three choices provided in this item— all public
schools/districts in the state, all non-public schools in the state, and/or all libraries in the state — and
indicate the two-letter state code. Please note that if your application represents SOME but not ALL of
any of these three types of entities, you should NOT check the statewide application box.

In addition, if you are a consortium that includes non-governmental entities ineligible for universal
service support, you should note that you cannot negotiate pre-discount prices below tariff rates for
interstate services from incumbent local telephone companies.

Item 5b

– Check all boxes that apply to you or any of the entities included in this specific form.

Item 6a

Provide the name of the person who should be contacted with questions about this application.
This person should be able to answer questions regarding the information included on this form and the
services you request.

Items 6b-6f

Provide the contact person’s mailing address. USAC will use this address to mail
correspondence about this form. If the contact person’s address information is the same as Item 4 above,
check the appropriate box instead. Also provide the contact person’s phone number, fax number, and e-
mail address. You MUST check your preferred mode of contact and provide the contact information for
your preferred mode. Wherever possible, the SLD will use this mode to contact you. In addition, in Item
6f, you may choose to provide an alternate telephone number, address, or an alternate contact name that
we may use during holiday/vacation/summer periods. Item 6f should contain only the name of the
alternate contact person – if appropriate – and an alternate phone number, fax number, or e-mail address.
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Item 6g

– If a consultant is assisting you with your application, provide the consultant’s name, employer,
street address, telephone number, fax, and e-mail. Also, provide the Consultant Registration Number. A
consultant is any non-employee of the entity applying for funding that assists in filling out the application
materials for a fee. “Non-employee” includes contractors or others who are employed by the entity on a
contract or short-term basis who does not receive a W-2 application from the entity filling out the
application. If the consultant does not have a Consultant Registration Number, the consultant can contact
CSB to obtain one. (See “Assistance in Completing this Form” above.) A consultant is any non-
employee of the entity applying for funding that is assisting in filling out the application materials for a
fee.

C. Block 2: [Reserved]

D. Block 3: [Reserved]


E. Block 4: Discount Calculation Worksheets


This block consists of one worksheet designed to meet the needs of those filing as:

• Schools/school districts.
• Libraries (outlet/branch, system).
• Consortia.

Applicants must complete a separate worksheet for each group of entities sharing one or more services.
School districts must also complete a worksheet listing all of the entities in the school district in order to
calculate the school district’s weighted average discount. Library systems must also complete a
worksheet listing all of the entities in the library system in order to calculate the library system’s shared
discount. In addition, if you are filing as a consortium, you may also need to include one or more
worksheets for individual school or school district consortium members and/or one or more worksheets
for library outlet/branch or library system members.

Below is a list of the columns that must be completed for the type of entity represented on the worksheet.
Detailed information for completing the worksheet follows this list.

For an individual school, complete:

• School District Name
• School District Entity Number
• Column 1 – Name of Eligible Entity
• Column 2 – Entity Number AND NCES Code
• Column 3 – Urban or Rural
• Column 4 – Total Number of Students (in the individual school)
• Column 5 – Number of Students Eligible for National School Lunch Program (NSLP) (in the
individual school)
• Column 6 – Percent of Students Eligible for NSLP (in the individual school)
• Column 7 – Discount from Discount Matrix
• Column 8 – New Construction
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• Column 9 – Administrative Entity or Non-Instructional Facility
• Column 10 – Alternative Discount Mechanism
• Column 12 – Pre-Kindergarten, Head Start, Adult Education, Juvenile Justice, Educational
Service Agency, or Dormitory

For a school district or group of schools in a school district sharing services, complete:

• A complete entry as defined above for each individual school
• Column 11 – Weighted Product for Calculating Shared Discount (for each individual school)
• Total of Column 4 entries
• Total of Column 11 entries
• Column 15 – Shared Discount
• If not already provided, a worksheet listing all of the entities in the school district showing the
weighted average discount for the school district.

For a library outlet/branch, complete:

• Library System Name
• Library System Entity Number
• Column 1 – Name of Eligible Entity
• Column 2 – Entity Number AND FSCS Code
• Column 3 – Urban or Rural
• Column 4 – Total Number of Students (in the public school district in which the library
outlet/branch is located)
• Column 5 – Number of Students Eligible for NSLP (in the public school district in which the
library outlet/branch is located)
• Column 6 – Percent of Students Eligible for NSLP (in the public school district in which the
library outlet/branch is located)
• Column 7 – Discount from Discount Matrix
• Column 13 – Entity Number of Public School District in which Library Outlet/Branch is Located

For a library system or group of library outlets/branches in a library system sharing services, complete:

• A complete entry as defined above for each library outlet/branch
• Total of Column 7 entries
• Column 15 – Shared Discount
• If not already provided, a worksheet listing all of the entities in the library system showing the
shared discount for the library system.

For a consortium, complete:

For the preparatory worksheets that determine the shared discounts for member entities that are
school districts, library systems, or subsets of those entities sharing services:

• One worksheet for each consortium member that is a school district or library system
• One worksheet for each group of individual schools in one school district or each group of
library outlets/branches in one library system that is sharing services.
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For each worksheet that determines the shared discount for member entities sharing services:

• A complete entry as defined above for each individual school or library outlet/branch that is a
consortium member
• An entry for each member entity represented by a preparatory worksheet, as follows:
o Column 1 – Name of Eligible Entity
o Column 2 – Entity Number
o Column 14 – Discount of Member Entity
o Total of Column 14 entries
o Column 15 – Shared Discount

Detailed Instructions

Discount Calculation for those entities filing as Schools/School Districts

If you checked the first or second box in Block 1, Item 5, you should use these instructions.

Item 9a -

If you are filing this application as:

• An individual school, you need only complete one line of Item 9a, Columns 1-10 and Column 12.
All of the services for which you are applying will be subject to the same site-specific discount you
calculate here.
• A school district serving more than one school, and you are requesting services that will go ONLY to
individual schools and will not be shared, complete Columns 1-10 and Column 12 of Item 9a for each
school. Also complete a worksheet listing all the entities in the school district, and check the
appropriate box at the top of the worksheet to verify that it includes all the entities in the school
district.
• A school district and ALL of the schools in your district will share one or more services (whether or
not those schools will also receive site-specific services), complete Columns 1-12 for each of your
schools PLUS Item 9b for school districts. Check the appropriate box at the top of the worksheet to
verify that it includes all the entities in the school district.
• A school district, but requesting that some services will be shared by some schools and not others
(whether or not those schools will also receive site-specific services), complete a separate worksheet,
Columns 1-12 PLUS Item 9b for school districts, for each different group of schools sharing a
service, which will result in a weighted average discount for that group of schools. You will then
label the worksheets 1, 2, 3, etc. Also complete a worksheet listing all the entities in the school
district, and check the appropriate box at the top of the worksheet to verify that it includes all the
entities in the school district.

Item 9b -

Use this item as instructed in Item 9a to calculate the appropriate discount(s).

Item 9a, Column 1:

For each school included in your application, list the school by name on a separate
row. For a new school under construction, if the name of the school is unknown when the Form 471 is
submitted, label this item “New School Construction.” If your district office or other administrative
building(s) in your district is eligible for services, give the name of the district office or other
administrative building.

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Item 9a, Column 2:

List each school’s Entity Number and NCES Code. If you do not know the Entity
Number or NCES Code for a particular school, contact CSB. CSB can also provide more information on
how to locate NCES Codes.

Item 9a, Column 3:

Indicate whether each school is located in an urban or a rural area. You should
base your assessment on the table posted in the “Rural/Urban Classification” information on the SLD
section of the USAC web site. Instructions accompanying the table will help you determine whether the
school is located in an urban or a rural area for purposes of the universal service support mechanism.

Calculating Each School’s Site-Specific Discount (Columns 4-10 and 12)


Item 9a, Column 4:

List the total number of K-12 students in each school. For “New School
Construction” or for an “Administrative Entity,” enter “0” in this item.

Item 9a, Column 5:

Provide the number of students eligible for NSLP as of the October 1st prior to the
filing of this form, or use the most current figure available. For “New School Construction” or for an
“Administrative Entity,” enter “0” in this item. You may choose to use an actual count of students
eligible for the NSLP or use federally approved alternative mechanisms to determine the level of poverty
for purposes of the universal service discount program. Schools using a federally approved alternative
mechanism may use participation in other income-assistance programs, such as Medicaid, food stamps,
Supplementary Security Income (SSI), federal public housing assistance (Section 8), or Low Income
Home Energy Assistance Program (LIHEAP) to determine the number of students that would be eligible
for the NSLP. See, e.g., 7 C.F.R. § 266.23. For more information, please refer to the “Alternative
Discount Mechanisms Fact Sheet” posted on the SLD section of the USAC web site at
http://www.usac.org/sl/applicants/step05/alternative-discount-mechanisms.aspx.

Item 9a, Column 6:

For each school, divide Column 5 by Column 4 to arrive at the percentage of
students eligible for NSLP. Discount calculations may be rounded up only when fully half a discount
point is reached. For example, an urban school with a discount eligibility of 34.499% will round down to
34%, and an urban school with a discount eligibility of 34.500% will round up to 35%. For eligibility
discounts of less than 1%, however, there is no rounding. For “New School Construction” or for an
“Administrative Entity,” leave this item blank.

Item 9a, Column 7:

Using the percentage in Column 6 and the Discount Matrix (see below), you should
determine the percentage discount to which the school is entitled. If you file online, the system will
calculate this figure for you. If you have any questions about determining this figure, contact CSB. For
“New School Construction” or for an “Administrative Entity” ONLY, enter the Weighted Average
Discount for the School District. A worksheet containing all the schools in the School District must be
submitted documenting the Weighted Average Discount for the School District. If you are submitting
your application on paper, a worksheet including all schools in the School District must be submitted and
the appropriate box checked at the top of the worksheet.

Item 9a, Column 8:

Check this box if the individual school is new school construction.

Item 9a, Column 9:

Check this box if the individual school is an administrative entity or non-
instructional facility (NIF).
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Item 9a, Column 10:

Check this box if the individual school used an alternative discount mechanism to
calculate its entry in Column 5 for the number of students eligible for NSLP.

Item 9a, Column 12:

Insert the appropriate code(s) in this box if the individual school includes pre-
kindergarten, head start, adult education, juvenile justice students and/or facilities, an Educational
Service Agency (ESA), or dormitory.

DISCOUNT MATRIX


INCOME

URBAN LOCATION

RURAL LOCATION

Measured by % of students eligible



for the National School Lunch


Program

Discount

Discount

If the percentage of students in your
…and you are in an URBAN
…and you are in a RURAL
school that qualifies for the
area, your
area, your
National School Lunch Program is…
discount will be…
discount will be…
Less than 1%
20%
25%
1% to 19%
40%
50%
20% to 34%
50%
60%
35% to 49%
60%
70%
50% to 74%
80%
80%
75% to 100%
90%
90%

Calculating a Shared Discount for the School District (Column 8 and Item 9b)


Item 9a, Column 11:

For each school receiving an appropriate share of shared services, multiply the
discount rate for the school (Column 7) by the number of students in the school (Column 4). If you file
online, the system will calculate this figure for you. The product is the school’s weighted product. For
“New School Construction” or for an “Administrative Entity,” leave this item blank.

Item 9b, Column 4:
Add all of the students in all of the schools listed, and enter the total into the last
cell at the bottom of Column 4. If you file online, the system will calculate this figure for you.

Item 9b, Column 11:

Add together all of the products in Column 11, and enter the total into the last cell
at the bottom of Column 11. If you file online, the system will calculate this figure for you.

Item 9b, Column 15:

Divide the total at the bottom of Column 11 by the total at the bottom of Column
4. Round the result to the nearest whole number percentage, and enter it into Column 15. Discount
calculations may be rounded up only when fully half a discount point is reached. If you file online, the
system will calculate this figure for you.

Discount Calculation for those entities filing as Libraries

If you checked the third box in Block 1, Item 5, you should use these instructions.



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Item 9a -

If you are filing this application as:

• A library consisting only of one outlet/branch, you need only complete one line of Item 9a, Columns
1-10 and Column 13. All of the services for which you are applying will be subject to the same site-
specific discount you calculate here.
• A library system with more than one outlet/branch, and you are requesting services that will go
ONLY to individual outlets/branches and will not be shared, complete Columns 1-10 and Column 13
of Item 9a for each outlet/branch. Also complete a worksheet listing all the entities in the library
system, and check the appropriate box at the top of the worksheet to verify that it includes all the
entities in the library system.
• A library system with more than one outlet/branch, and ALL of the outlets/branches will share one or
more services (whether or not those outlets/branches will also receive site-specific services),
complete Columns 1-10 and Column 13 PLUS Item 9b for library systems. Check the appropriate
box at the top of the worksheet to verify that it includes all the entities in the library system.
• A library system with some of the services you are requesting shared by some outlets/branches and
not others (whether or not those outlets/branches will also receive site-specific services), complete a
separate worksheet, Columns 1-10 and Column 13 PLUS Item 9b for library systems, for each
different group of outlets/branches sharing a service. You will then label the worksheets 1, 2, 3, etc.
Also complete a worksheet listing all the entities in the library system, and check the appropriate box
at the top of the worksheet to verify that it includes all the entities in the library system.

Item 9b -
You will use this item as instructed in Item 9a to calculate the appropriate discount(s).

Item 9a, Column 1:

For each library outlet/branch included in your application, list the library
outlet/branch by name on a separate row. For a new library under construction, if the name of the library
is unknown when the Form 471 is submitted, label this item “New Library Construction.” If your library
system office or other administrative building(s) is eligible for services, give the name of the library
system office or other administrative building.

Item 9a, Column 2:

List the Entity Number and FSCS Code for each library outlet/branch. If you do
not know the Entity Number or FSCS Code for a particular library outlet/branch, contact CSB. CSB can
also provide more information on how to locate FSCS Codes.

Item 9a, Column 3:

Indicate whether each library outlet/branch is located in an urban or a rural area.
You should base your assessment on the table posted in the “Rural/Urban Classification” information on
the SLD section of the USAC web site. Instructions accompanying the table will help you determine
whether the library outlet/branch is located in an urban or a rural area for purposes of the universal
service support mechanism.

Calculating the Site-Specific Discount for Each Library Outlet (Columns 4-10 and 13)

The level of poverty for a library outlet/branch is based on the percentage of student enrollment that is
eligible for a free or reduced price lunch under the NSLP or a federally approved alternative mechanism
in the public school district in which the library is located. If you are using the percentage of students
eligible for the NSLP, you may generally obtain the necessary information by contacting your local
public school district.

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Item 9a, Column 4:

List the total number of K-12 students in the public school district in which the
library outlet/branch is located. For “New Library Construction” or for an “Administrative Entity,” enter
“0” in this item.

Item 9a, Column 5:

Provide the number of students eligible for the National School Lunch Program
(NSLP) in the public school district in which the library outlet/branch is located as of the October 1st
prior to the filing of this form, or use the most current figure available. For “New Library Construction”
or for an “Administrative Entity,” enter “0” in this item. You may choose to use an actual count of
students eligible for the NSLP or use federally approved alternative mechanisms to determine the level of
poverty for purposes of the universal service discount program. Libraries using a federally approved
alternative mechanism may use participation in other income-assistance programs, such as Medicaid,
food stamps, Supplementary Security Income (SSI), federal public housing assistance (Section 8), or Low
Income Home Energy Assistance Program (LIHEAP) to determine the number of students that would be
eligible for the NSLP. See, e.g., 7 C.F.R. § 266.23. For more information, please refer to the
“Alternative Discount Mechanisms Fact Sheet” posted on the SLD section of the USAC web site at
http://www.usac.org/sl/applicants/step04/alternative-discounts.aspx.

Item 9a, Column 6:

For each library, divide Column 5 by Column 4 to arrive at the percentage of
students eligible for the NSLP in the public school district in which the library outlet/branch is located.
Discount calculations may be rounded up only when fully half a discount point is reached. For example,
an urban library with a discount eligibility of 34.499% will round down to 34%, and an urban library
with a discount eligibility of 34.500% will round up to 35%. For eligibility discounts of less than 1%,
however, there is no rounding. For “New Library Construction” or for an “Administrative Entity,” leave
this item blank.

Item 9a, Column 7:

Using the percentage in Column 6 and the Discount Matrix (see below), you should
determine the percentage discount to which the library outlet/branch is entitled. If you file online, the
system will calculate this figure for you. If you have any questions about determining this figure, contact
CSB. For “New Library Construction” or for an “Administrative Entity” ONLY, enter the shared
discount for the Library System. A worksheet containing all the library outlets/branches in the Library
System must be submitted documenting the shared discount for the Library System. If you are
submitting your application on paper, a worksheet including all library outlets/branches in the Library
System must be submitted and the appropriate box checked at the top of the worksheet.

DISCOUNT MATRIX

INCOME

URBAN LOCATION

RURAL LOCATION

Measured by % of students eligible



for the National School Lunch


Program

Discount

Discount

If the percentage of students in your
…and you are in an URBAN
…and you are in a RURAL
school that qualifies for the
area, your
area, your
National School Lunch Program is…
discount will be…
discount will be…
Less than 1%
20%
25%
1% to 19%
40%
50%
20% to 34%
50%
60%
35% to 49%
60%
70%
50% to 74%
80%
80%
75% to 100%
90%
90%
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Item 9a, Column 8:

Check this box if the individual library is new library construction.

Item 9a, Column 9:

Check this box if your library system office or other administrative building(s) in
your library system is eligible for services or is a non-instructional facility (NIF) such as a bookmobile
garage, or a library technology center without areas accessible to the public.

Item 9a, Column 10:

Check this box if the library used an alternative discount mechanism to calculate
its entry in Column 5 for the number of students eligible for NSLP.

Item 9a, Column 13:

List the entity number of the school district in which the library outlet/branch is
located.

Calculating the Shared Discount for the Library System

Item 9b, Column 7:

Add up all of the discounts in this column and enter the total in the cell at the
bottom of Column 7. If you file online, the system will calculate this figure for you.

Item 9b, Column 15:

Divide the total at the bottom of Column 7 by the total number of library
outlets/branches listed in Column 1. Round the result to the nearest whole number percentage, and list
this number in Column 15. Discount calculations may be rounded up only when fully half a discount
point is reached. This is the library system’s shared discount. If you file online, the system will calculate
this figure for you.

Discount Calculation for Consortia

If you checked the fourth box in Block 1, Item 5, as a consortium of schools, school districts, libraries
(outlets/branches, systems) or any combination of the above, you should use these instructions.

Item 9a -

If you are filing this application as:

• A consortium and you are requesting services that will go ONLY to an individual consortium
member and will not be shared,
o For an individual school or library outlet/branch member entity, enter a complete line as
described above if you have not already done so on another worksheet.
o For a school district or library system member entity, complete a worksheet as described
above.
• A consortium and if ALL consortium members will share one or more services (whether or not those
consortium members will also receive site-specific services),
o For an individual school or library outlet/branch member entity, enter a complete line as
described above plus Column 14 for each member entity.
o For a school district or library system member entity, complete a separate worksheet to
calculate the discount for that entity as described above, then complete Columns 1, 2 and 14
for each member entity.
o When you have listed all your member entities that will share these services, complete Item 9b
for consortia.
• A consortium, and some requested services will be shared by some consortium members and not
others (whether or not those consortium members will also receive site-specific services), you must
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OMB 3060-0806
complete a separate worksheet for shared services as described above for each different group of
consortium members sharing a service. You will then label the worksheets 1, 2, 3, etc.

Item 9b -

You will use this item as instructed in Item 9a to calculate the appropriate discount(s).

Item 9a, Column 1:

For each eligible consortium member included in your application, list the member
by name on a separate row. Do not list ineligible consortium members, as they will not receive
discounted services.

Item 9a, Column 2:

List each eligible consortium member’s Entity Number and NCES Code (for
schools) or FSCS Code (for libraries). If you do not know the Entity Number, NCES Code, or FSCS
Code for a particular eligible consortium member, contact CSB. CSB can also provide more information
on how to locate NCES Codes and FSCS Codes.

Calculating the Site-Specific Discount for Each Member (Column 14)

Item 9a, Column 14:

Provide the correct discount for each eligible member depending on the type of
entity it is.

• If the member is an individual school, use the discount from Column 7. You may attach a completed
worksheet showing the calculations for an individual school that is a member of your consortium, or
you may enter a completed line for that school on your consortium worksheet.
• If the member is a school district, use the discount from Item 9b, Column 15 of the worksheet for the
school district. Attach the completed worksheet showing the calculations for each school district that
is a member of your consortium.
• If the member is a library outlet/branch, use the discount from Column 7. You may attach a
completed worksheet showing the calculations for an individual library outlet/branch that is a
member of your consortium, or you may enter a completed line for that library outlet/branch on your
consortium worksheet.
• If the member is a library system, use the discount from Item 9b, Column 15 of the worksheet for the
library system. Attach the completed worksheet showing these calculations for each library system
that is a member of your consortium.

Calculating the Shared Discount for the Consortium (Columns 14-15)

Item 9b, Column 14:

Add up all of the discounts in Column 14 and enter the total in the cell at the
bottom of this column. If you file online, the system will calculate this figure for you.

Item 9b, Column 15:

Divide the total at the bottom of Column 15 by the total number of consortium
members listed in Column 1. Round the result to the nearest whole number percentage, and list this
number in Column 15. Discount calculations may be rounded up only when fully half a discount point is
reached. This is the shared discount for the entire consortium. If you file online, the system will
calculate this figure for you.


F.

Block 5: Discount Funding Request(s)


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Block 5 asks you to provide information about the eligible services that you have ordered, their cost, and
the discount you are requesting based on the entities to receive service. The following information will
highlight the features of Block 5.

You will complete one Block 5 for each Funding Request. In general, you should complete a separate
Funding Request page for:

• Each service provider that will be providing you with service.
• Each separate contract (but not necessarily the individual service within that contract, as long as
they are in the same category of service, e.g., Internal Connections Other than Basic
Maintenance).
• Each different category of service provided by the same provider. For example, a PBX system
that the applicant will purchase and own and local voice service from the same telephone
company must go on separate Funding Requests, because the PBX is categorized as Internal
Connections and the phone service is categorized as Telecommunications Services. Check the
“Eligible Services List” and any updates on the SLD section of the USAC web site to identify the
category where each service belongs.
• Local phone service.
• Long distance phone service (if, for example, your long distance service is billed separately from
your local phone service on a bill from a different service provider).
• Site-specific services (services not shared by other sites).
• Services ordered based on different Forms 470. Services corresponding to each Form 470 must
be reported on separate Funding Requests with the relevant Form 470 Application Numbers.
This includes services ordered from the same service provider in the same category of service if
the order is based on different Forms 470.

Ineligible costs:

You may not seek support for ineligible services, entities, and uses, nor should you
inflate your funding request beyond what you are able to substantiate as your likely costs during the
funding year. Block 5 will guide you through deducting any ineligible costs from your total cost of
services before calculating your discount request. If you have any questions about whether a service
is eligible for support, please check the “Eligible Services List” on the USAC web site or contact
CSB.

Signed contracts:

You MUST have a signed contract for all services you order on your Form 471 if
required by state law except:

Tariffed services: Telecommunications services that you purchase at prices regulated by
your state regulatory commission and/or the FCC, for which you do not have a signed,
written contract.
Month-to-Month Services: Month-to-month services for which you do not have a signed,
written contract. Your billing arrangement signifies that you are receiving your services on a
month-to-month basis.
State Master Contracts: A signed state master contract between the state and service
provider(s) meets the FCC’s signed contract requirement. There may be additional state
master contract and/or local or state procurement requirements.

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Note: You must file a Form 470 and seek competitive bids for non-contracted tariffed or month-to-
month services each funding year, unless the services are part of a multi-year contract.

Eligible service providers:

To provide you with eligible services under this program, service
providers must secure a Service Provider Identification Number (SPIN) from USAC and certify that
they will comply with program rules.

Item-by-Item Instructions


Funding Request Number (FRN) –

The SLD will assign and insert a unique number to each funding
request. Leave this item blank.

Item 10

– If this is a duplicate funding request (e.g., of an FRN from this or another funding year that is
not yet approved, under appeal, etc.), check this box and enter the original FRN in the space provided.

Item 11 –

Check the correct category for the service listed on this Funding Request. You may check
only ONE category. Please consult the “Eligible Services List” and any updates on the web site or
contact CSB.

Item 12 –

Provide the 15-digit Form 470 Application Number of the Form 470 in which the services
ordered here were sought. This number appears on your Form 470 Receipt Notification Letter.

Item 13 –

Enter the 9-digit Service Provider Identification Number (SPIN) for this service provider. You
must provide a valid SPIN for the service provider indicated in Item 14 below. Each service provider
should give you its SPIN on request. You may refer to the “SPIN Search” area of the web site for a list
of service provider contacts. A service provider who does not have a SPIN must file an FCC Form 498
to obtain one. The Form 498 and Instructions can be downloaded from the Service Provider Forms area
of the USAC web site.

Item 14
– Provide the full legal name of the service provider for this Funding Request. You may list
only ONE service provider per FRN. The name of your service provider whose SPIN is indicated in Item
13 above must be provided. If you file online, the system will populate this information for you.

Item 15

– Provide the appropriate contract information for this service.

Item 15a

– If this funding request is for a non-contracted tariffed or month-to-month service, check
this box.
a. Tariffed services. A tariffed service is a telecommunications service that you purchase at prices
(rates) regulated by your state regulatory commission and/or the FCC, for which you do not have
a signed, written contract.
b. Month-to-month services. Certain services are commonly offered on the basis of a month-to-
month arrangement where there may be no contract between the customer and the service
provider. These include services such as Internet access, cellular services and paging services.
These arrangements are different from tariffed services, which may also be offered month-to-
month but at regulated prices.

Item 15b

– If you are receiving services under a contract, enter the contract number in Item 15b.
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a. If this is a contracted service and the contract does not have a contract number but has some
other reference number, you should note that number in Item 15b.
b. If you are buying off of a master contract signed by a state, regional or local procurement agency
on behalf of eligible schools and libraries, you may use either the state master contract number or
the number of your own purchase agreement executed pursuant to that master contract.
Whichever number you use, be certain that you use the corresponding dates in Item 18 and Item
20b.
c. If you checked Item 15a, enter “T” for tariffed services or “MTM” for month-to-month services
in Item 15b.

Item 15c

– Check this box if this funding request is covered under a master contract – a contract
negotiated by a third party, the terms and conditions of which are then made available to an eligible
entity that purchases directly from the service provider.

Item 15d

– Check this box if this funding request is a continuation of an FRN from a previous
funding year based on a multi-year contract. If so, enter that FRN in the space provided.

Item 16 –

Provide the account number that your service provider has established with you for billing
purposes. This information will help your service provider provide you with discounted bills for service.
In the case of telephone services, this is most often the billed telephone number associated with the
service.

If there are multiple billed telephone numbers or multiple Billing Account Numbers,
provide one main number in Item 16a, check the box in Item 16b, and attach a list of all the
numbers to this page of your application.

If this service is already established (for example, a service
provided under a qualified existing contract, or tariffed services for which you have selected the same
service provider who already provides you with service), you should be able to find your account number
on past bills, or you can request your account number from the service provider. If you have not yet
established an account number, your service provider may have a “pre-account” identifier for you to use.

Item 17 –

List the Allowable Vendor Selection/Contract Date for this service. The Allowable Vendor
Selection/Contract Date is the earliest date after posting the Form 470 that you are permitted to select
your service provider and to sign a contract for newly contracted services, as applicable. This Allowable
Vendor Selection/Contract Date for the Form 470 cited in Item 12 above is identified in your Receipt
Notification Letter and – in the Form 470 posted – on the SLD section of the USAC web site. If you file
online, the system will populate this information for you. Note, however, that if you issued a Request for
Proposals (RFP) after you posted your Form 470, your Allowable Vendor Selection/Contract Date may
be later than the date identified on your Form 470 Receipt Notification Letter.

Item 18 –
For contracted services, enter the date that your contract for this service was signed, using
mm/dd/yyyy format.
a. For non-contracted tariffed services and month-to-month services, leave this item blank.
b. If this funding request is covered under a state master contract but the state did not file a Form
470, enter the date that you chose the state master contract as the most cost-effective offering
pursuant to your posted Form 470, rather than the date that the state master contract was actually
signed.

Item 19 –

For all services, provide the date when services will start in the funding year for which you
are applying, using mm/dd/yyyy format. In general, discounts will NOT be provided for services
delivered before the beginning of the funding year, which starts on July 1. Thus, if this service has
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OMB 3060-0806
already started by the time you file this Form 471, you will use July 1 of the funding year as your Service
Start Date.

Item 20a –

For non-contracted services, enter the date that services will end in the funding year for
which you are applying, using mm/dd/yyyy format.

Item 20b –

For contracted services, enter the date the contract expires, in mm/dd/yyyy format. For non-
contracted tariffed services and month-to-month services, leave this item blank.

Item 21

– Each Funding Request must include a description of the products and services for which
discounts are being sought. This description is known as an “Item 21 Attachment.” The Item 21
Attachment is a detailed and complete narrative description of the products and services contained in the
funding request and a line-item listing of the products and/or services requested with their associated
costs, including make, model number and location of any equipment. Each description must be labeled
with a unique “Attachment Number” that you create. For Item 21, please enter the Attachment Number
you have created.

You must submit your Item 21 Attachment to the SLD online or via e-mail, fax or mail on or before the
last day of the filing window. (See “Item 21 Attachments For Form 471” posted in the Reference Area of
the SLD section of the USAC web site.)

You may cite the same description of services in multiple Funding Requests. For example, if you are
ordering Internal Connections products and services (other than Basic Maintenance) under a single
contract for multiple sites and the products and services are the same for each site, each Funding Request
may refer to a single Item 21 Attachment.

Service providers can assist applicants in the preparation of the Item 21 Attachment, which also must
include:

• The applicant’s name
• The Attachment Number (see above)
• The applicant’s Billed Entity Number, and
• The Form 471 application number, if one has been assigned through online filing.

The line-item listing of products and services may be submitted in a table format as follows:
-----Extended Cost-----
Quantity
Description of Product or Service
Unit Cost
Recurring
Non-Recurring
















Sufficient information must be provided so that the installation location is clearly identified. “One per
school, district office, or Entity Number 12345” may be used for the location description.

In some circumstances, additional information may be required. For example:

• Ensure that any included ineligible products and/or services are identified and the cost of such
products and/or services is deducted.
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• For maintenance services, include the specific list of components to be covered and break out the
pricing for maintenance of these components. (Note that for Priority 2 services, Basic
Maintenance of Internal Connections is a separate category of service from Internal
Connections.)
• For telephone services, indicate the number of phone lines and/or cell phones receiving service,
and provide information about their use if any will be used for other than educational purposes.
• A price quotation from the service provider, a representative bill for continuing services, or the
criteria used to estimate new or increased cost, may be submitted if sufficient detail is provided
in that documentation to determine the eligibility of the funding request.
• If products or services are being purchased under a state master contract, include the contract
number (if available) and the expiration date of the state master contract.
• Include an explanation of the purpose, breakdown of up-front costs, or other information to
provide a clear explanation of the funding request.

If questions arise during review of an application, the SLD may need to reach out to you to request
additional information. For this reason, you can significantly speed up the application review process by
including complete information in the Item 21 Attachment.

Item 22 –

For site-specific services that will be provided to one individual entity and not shared by
others (for example, a local area network to be installed in one school building), provide the Entity
Number of the individual entity receiving that service. For shared services used jointly by multiple
entities (such as telecommunications services provided to all of the outlets/branches in a library system),
list the Block 4 Worksheet Number that shows the sharing entities and calculates the shared discount for
this service.

Item 23

Use the step-by-step calculation grid to arrive at the total amount of your funding request.
You may round dollar amounts to the nearest dollar, but please use numerals and include all digits.

DO
NOT use words such as 1 million

, in place of 1,000,000. Note that if you are seeking support on multi-
year contracts, you may request funding only for that portion of the contract that is delivered in the
relevant funding year.


Use Items 23A-23E for recurring charges (monthly charges) for this service, and Items 23F-23H for
non-recurring charges (one-time charges) for this service.

You may request discounts only for products and services delivered in the relevant funding year.
Recurring services must be delivered between July 1 and June 30 of the funding year. Non-recurring
services must generally be delivered between July 1 and the September 30 following the close of the
funding year. For more information, please refer to “Service Delivery Deadlines and Extension
Requests” on the SLD section of the USAC web site.

Item 23A –

Enter your total monthly cost for this service. If the cost of service fluctuates from month to
month, you may use the average of past bills to estimate the monthly cost.

If you expect to pay a non-recurring charge in multiple installments over the funding year, you should
either amortize this charge in Items 23A-23E or include the full amount of this charge in Items 23F-23H.

DO NOT

include this amount under both recurring and non-recurring charges.

If you amortize this
charge in items 23A-23E, you will not be eligible for discounts on any non-recurring services in this
funding request provided after June 30 of the funding year.


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Item 23B –
Enter the total cost associated with ANY ineligible services, entities, or uses included in your
monthly charges. The following represent some common ways in which eligible and ineligible costs are
bundled together, and how you can go about deducting the ineligible costs.

Eligible services bundled with ineligible services:

While you may contract with the same service
provider for both eligible and ineligible services, your contract must clearly break out costs for
eligible services from those for ineligible services. If the eligible and ineligible services were
purchased together at a special “bundled” price, a proportionate cost allocation is required between
the eligible and ineligible components. You will use this reduced price when requesting universal
service discounts on the eligible service. For example, if a provider offers to sell a school an eligible
service for $10.00 and an ineligible service for $20.00, but also offers them as a bundle for $24.00,
this would indicate that the provider is offering a $6.00, or 20%, price reduction. Therefore, the
school could treat $10.00 * 80% = $8.00 as eligible for universal service support.

Services shared by eligible and ineligible entities:

When you share a service with an ineligible
entity, the provider may receive reimbursement only for that portion of the service that eligible
entities are receiving. To help auditors confirm that this rule is being observed, you must keep and
retain careful records of how you have allocated the costs of shared services and facilities among
eligible and ineligible entities. You are required to maintain these records consistent with any
measures that may be established by the FCC, the SLD, or state commissions.

Bundled services from an Internet service provider:

You may receive discounts on access to the
Internet but not on separate charges for particular proprietary content or other information services.
In addition, if you choose a package including content and conduit, you may only receive a discount
on the conduit portion of the package. The only exception is when the bundled package includes
minimal content and provides a more cost-effective means of securing access to the Internet than
other non-content alternatives. Thus, if a service provider bundles Internet access with a package of
content that is available to all customers free of charge, the entire price of that bundle will be eligible
for support. However, if the service provider a) does not offer an access-only service, and b) offers
Internet users access to its proprietary content for a price, then you must treat the difference between
the content-only price and the price the service provider charges for its bundled access as the price of
non-content Internet access.

Item 23C –
Subtract the amount in Item 23B from the amount in Item 23A to arrive at your eligible
monthly pre-discount cost.

Item 23D –

Provide the number of months you will be receiving this service in the funding year.

Item 23E –
Multiply Item 23D by Item 23C to arrive at your annual pre-discount cost for eligible
recurring services.

Item 23F –

Enter your total annual amount of non-recurring (one time) pre-discount charges for this
service.

Item 23G –

Provide the total cost of non-recurring services associated with any ineligible service,
entities, or uses included in your total annual cost of service. See notes on Item 23B, above, for more
information.
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OMB 3060-0806

Item 23H –
Subtract the amount in Item 23G from the amount in Item 23F to arrive at your total eligible
pre-discount cost for non-recurring services.

Item 23I –

Add together Items 23E and 23H to arrive at your total eligible pre-discount costs (recurring
and non-recurring) for the year.

Item 23J –

Enter the correct discount for this service, which is the discount you calculated for the entity
or entities cited in Item 22. Refer back to the appropriate Block 4 worksheet to ensure that you enter the
correct discount.

Item 23K –
Multiply the amount in Item 23I by the discount in Item 23J to arrive at your total funding
commitment requested for this service.

Item 24 –

Description of Broadband Services Ordered for Schools and Libraries from this funding
request

This item is required to help the SLD document the impact of the universal service program for schools
and libraries across the country, and compare that impact from year to year. Complete the information
for this funding request only if requesting Telecommunications Services or Internet Access for the
purpose of providing broadband connectivity to school and/or library facilities. Check the box if the
request is for services or equipment that do not providing broadband or connectivity. For instance, check
the box if the funding request is for internal connections, basic maintenance, or requests for services like
e-mail or phone service.

A response to this Item is not a substitute for a complete response to Item 21 but should be consistent
with the description of services in the response to Item 21. Please ask your service provider if you need
assistance.

Item 24a –

List the number of lines and average speed for the lines included in this funding request. If
there are multiple speeds for the lines within one type of broadband connection, provide that information
in one of the two additional lines provided beneath the broadband type entry. If you need additional
space, please makes copies of this page and number the completed pages to assure that they are all
processed correctly.

The average speeds for three types of broadband connections (dial-up, T1/DS-1, and T3/DS-3) are
already filled in since the speeds for each are standard.

Item 24b
– Estimate the percentage of the school classroom or public library rooms included in the
Block 4 worksheet for this FRN that will have access to wired drops and Wi-Fi connections. Note that
the two percentages do not need to equal 100 percent.

Item 24c

– For consortia and statewide applications, indicate whether the connections in this funding
request include the last mile connection to the school or library. If the request does not include the last
mile connection, indicate whether these connections are only for the backbone connections.



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G.

Block 6: Certifications and Signature



Block 6 requires program participants to certify certain information. This information is required to
ensure that only eligible entities receive support under the universal service discount mechanism.

“Do Not Write In This Area” - The SLD uses this space to apply a bar code to your form upon receipt,
so that we can properly track and archive your form.

Special Block 6 Instructions for Applications Filed Online


• When you have completed the online filing of Blocks 1-5, please print your application to retain a
copy for your records.

• You must also submit the Block 6 certification.

• If you have a PIN and wish to submit your Block 6 certification online, follow the directions
online. When you submit your certification online, you will receive a confirmation. If you file
online and use online certification, do not mail any part of your Form 471 to the SLD. If you are
submitting your Item 21 attachment or any other required documents on paper, make a copy of
the online certification confirmation page and attach that to the top of the Item 21 attachment,
and any other required documents, so that the SLD will be able to match the Item 21 attachment,
and any other required documents, with the correct Form 471.

• If you wish to submit the completed and signed Block 6 certification on paper, print Block 6
using your browser. When you print Block 6 using the browser, the form will automatically
include your Form 471 Application Number, Applicant Name, and Applicant Address. Item 38
requires the signature of the authorized person who certifies to the accuracy of the information
on the form. Also, you must complete Items 24-42e. Mail the signed Block 6 to:

SLD-Form
471, P. O. Box 7026, Lawrence, Kansas 66044-7026.

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

SLD-Forms 471, ATTN: SLD Form 471,
3833 Greenway Drive, Lawrence, Kansas 66046

. Note: Do not mail the complete Form 471.
Mail only the signed Block 6 certification page along with your Item 21 description of services
and any other required documents. If the Block 6 certification is submitted on paper, you are
advised to keep proof of the date of mailing.

For all applicants, filing on paper or online:

Item 25

– Certify that the entities represented are eligible schools and/or libraries.

Item 26

– Check this box to certify that you can demonstrate that you have secured access to all of the
resources necessary to make effective use of the products and services for which they receive discounts.

As part of our review of your Item 25 certification, the SLD may request additional documentation to
support your certification. The certification in Item 32 below states that you will retain for at least five
years (or whatever retention period is required by the rules in effect at the time of certification), after the
last day of service delivered any and all worksheets and other records that you rely upon to fill out your
Form 471. For Item 25, these worksheets and records include:

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OMB 3060-0806

Paying your share of E-rate eligible costs.

You may be asked to provide documentation of
your ability to pay the non-discount portion of the products and services for which you have
applied for discounts. You are required to already have the funds identified in your budget to
pay for these costs. If your budget is not yet final, we may request additional documentation to
substantiate your certification.

Paying for ineligible costs.

You may be asked to provide more detailed estimates of hardware,
software, professional development, retrofitting (construction and electrical work necessary to
prepare a building for technology), maintenance investments and other resources that are
necessary to make effective use of the E-rate discounts you have requested. If these resources
will be purchased under your budget, you must already have the funds identified in your budget
to pay for them. However, these resources may also be ones that you already have or own, such
as computers purchased or donated in a prior year.

Technology Plan.

You may be asked to provide a copy of your Technology Plan. Your
Technology Plan should include a description of the products and services necessary to
accomplish your technology service goals, whether they are eligible or ineligible for E-rate
discounts.

Status of technology before and after E-rate discounts.

You may be asked to provide a more
detailed estimate of the level of technology for all recipients of discounted services included in
your application. This estimate would describe the level of technology for each recipient both at
the beginning of the funding year and after the planned products and services in your technology
plan are delivered and installed.

Item 26a

– Add your entries from Items 23I, Total funding year pre-discount amount, on all Block 5
Discount Funding Requests and enter the total here. If you file online, the system will calculate this
figure for you.

Item 26b

Add your entries from Items 23K, Funding Commitment Request, on all Block 5 Discount
Funding Requests and enter the total here. If you file online, the system will calculate this figure for you.

Item 26c

– Subtract Item 25b from Item 25a and enter the result here. This is the total non-discount
share for the funding requests on this Form 471. Remember that applicants are required to pay this non-
discount portion of the cost of E-rate eligible products and services to their service providers. If you file
online, the system will calculate this figure for you.

Item 26d

– Enter the total amount in your budget that has been allocated for resources not eligible for E-
rate support. These are the resources that are necessary for you to support and improve education and
library services and to make effective use of the eligible services you have requested in all Block 5
funding requests across all Forms 471 you will submit for this funding year. These resources may
include, but are not limited to:

• Hardware, such as computers, printers, fax machines, video equipment, scanners, CD-ROM
drives, and servers;
• Professional development, such as ongoing technology-related training for technical staff,
teachers and/or librarians;
• Software, such as end-user applications;
• Maintenance, such as systems maintenance and operations costs for ineligible hardware and
software and salaries of technical staff;
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OMB 3060-0806
• Retrofitting, such as electrical wiring, asbestos removal, building modifications, renovations, and
repairs.

If you file multiple Forms 471 for this funding year, you must calculate your total budgeted amount
allocated for these resources and enter that total on Item 25d of each Form 471. Consortia must add the
budgeted amounts for all of their member entities and enter that total on this line.

Item 26e

– Add your entries for Item 25c and Item 25d and enter the total here. This is the amount
necessary to pay the non-discount share of the services requested on this Form 471 AND to make
effective use of the discounts requested on all your applications for this funding year. This amount will
not include amounts necessary to pay the non-discount share of requests on other Forms 471.

Item 26f –

Check this box if your service provider has provided direct financial assistance to you for any
of the funds in Item 25c or Item 25d. Also, check this box if your service provider assisted you in
locating funding for any of the funds in Item 25c or Item 25d. Service providers may assist applicants in
locating grants and donations consistent with program rules and the Obligation to Pay Non-Discount
Portion notice on the SLD section of the USAC web site. Service providers may provide assistance to
applicants for ineligible products and services consistent with program rules and the Free Services
Advisory as explained on the web site.

Item 27

– Certify that (1) any required technology plan does or will cover all 12 months of the funding
year, and has been or will be approved by a state or other authorized body or an SLD-certified technology
plan approver prior to the commencement of service; or (2) certify that no technology plan is required by
Commission rules.

Item 28

– Check this box to certify that you have posted your Form 470 (if applicable) and made your
RFP available for at least 28 days (if applicable) before considering all bids received and selecting a
service provider in accordance with program rules.

Item 29

– Check this box to certify that the entity responsible for selecting the service provider has
reviewed all applicable competitive bidding requirements and complied with them.

Item 30 –

Check this box to certify that services you order pursuant to the universal service discount
mechanism will be used primarily for educational purposes and will not be sold, resold, or transferred for
gain. Additionally, you certify that the entities listed on this application have not received anything of
value in connection with this request for services.

Item 31

– Check this box to certify that you and the entity(ies) you represent have complied with all
program rules, including recordkeeping requirements, and that you acknowledge failure to do so may
result in denial of discount funding and/or cancellation of funding commitments. You also certify that
there are signed contracts covering all of the services listed on this Form 471 except for those services
provided under non-contracted tariffed or month-to-month arrangements. You acknowledge that failure
to comply with program rules could result in civil or criminal prosecution by the appropriate law
enforcement authorities.

Item 32
– Check this box to certify that you understand that the discount level used for shared services is
conditional, for future years, upon ensuring that the most disadvantaged schools and libraries that are
treated as sharing in the shared services receive an appropriate share of benefits from those services.
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OMB 3060-0806

Item 33

– Check this box to certify that required documents will be retained for a period of at least five
years (or whatever retention period is required by the rules in effect at the time of this certification), after
the last day of service delivered and to acknowledge that you may be audited pursuant to participation in
the schools and libraries program.

Item 34

– Check this box to certify that you are the person authorized to order telecommunications and
other supported services on behalf of the eligible entity(ies) and are authorized to submit and certify to
the accuracy of this form.

Item 35

– Check this box to acknowledge that FCC rules provide that persons who have been convicted
of criminal violations or held civilly liable for certain acts arising from their participation in the schools
and libraries support mechanism are subject to suspension and debarment from the program. You agree
to institute reasonable measures to be informed, and will notify USAC should you be informed or
become aware that you or any of the entities named on this Form 471, or any person associated in any
way with your entity and/or the entities named on this Form 471, is convicted of a criminal violation or
held civilly liable for acts arising from their participation in the schools and libraries support mechanism.

Item 36

– Check this box to certify that if any of the Funding Request Numbers on this Form 471 contain
requests for discounts for products or services that contain both eligible and ineligible components, that
you have allocated the cost of eligible and ineligible components as required by the Commission's rules.

Item 37

– Check this box to certify that this funding request does not constitute a request for internal
connections services, except basic maintenance services, in violation of the Commission requirement that
eligible entities are not eligible for such support more than twice every five funding years beginning in
Funding Year 2005.

Item 38
– Check this box to certify that the non-discount portion of the costs for eligible services will not
be paid by the service provider, and that the pre-discount costs of eligible services featured on this Form
471 are net of any rebates or discounts offered by the service provider.

Item 39

– Requires the signature of the authorized person.

Item 40 –

Provide the date of signature of the Form 471. Note that for applications requesting new
services, this date CANNOT be earlier than any Allowable Vendor Selection/Contract Date you cited in
Item 17 of any Block 5 submitted with this application.

Item 41
Print the name of the authorized person whose signature is provided in Item 38.

Item 42

Provide the title or position of the authorized person whose signature is provided in Item 38.
If the consultant in Item 6g is the Authorized Person, check the appropriate box.

Item 43a–43d –

Provide the mailing address, the telephone number, the fax number and the e-mail
address of the authorized person whose signature is provided in Item 38.

Item 43e –

Provide the name of the authorized person’s employer. If a consultant is acting as the
authorized person, provide the name of the company that employs the consultant, not the name of the
applicant organization.
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FCC Form 471 Instructions – December 2013



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