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Commission Document Attachment

DA-13-1636A3

FCC Form 479
Approval by OMB
Control No. 3060-0853
Estimated time per response: 1 hour

Schools and Libraries Universal Service

Certification by Administrative Authority to Billed Entity of Compliance with the Children's Internet Protection Act

Instructions for Completing the

Schools and Libraries Universal Service

Certification by Administrative Authority to Billed Entity of Compliance with the Children's Internet Protection Act

(FCC Form 479)

TABLE OF CONTENTS

NOTICE

Page 1

I.

PURPOSE OF FORM

Page 1

II. IMPACT OF CIPA REQUIREMENTS ON FCC FORM 479

Page 2

III. SUBMISSION REQUIREMENTS AND GENERAL INSTRUCTIONS

Page 3

IV. SPECIFIC INSTRUCTIONS

Page 4

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 be 1 hour 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.

PURPOSE OF FORM

The FCC Form 479, Certification by Administrative Authority to Billed Entity of Compliance with the Children's Internet
Protection Act, provides notification to a Billed Entity by an Administrative Authority of the status of the Administrative
Authority's compliance for the purposes of CIPA. The Billed Entity will then certify on its FCC Form 486, Receipt of
Service Confirmation and Certification of Compliance with the Children's Internet Protection Act and Technology Plan
Requirements Form , that it has collected duly completed and signed FCC Forms 479 from Administrative Authorities that
the Billed Entity represents. Starting in Funding Year 2002 (the Funding Year beginning July 1, 2002), FCC Form 479
also provides notification to the Billed Entity of a request for waiver by the Administrative Authority.
Throughout these instructions, the Administrative Authority may also be referred to as "you."

OMB Control No. 3060-0853

Note that this form must be used beginning with Funding Year 2001 (the Funding Year beginning July 1, 2001)
and later.

II.

IMPACT OF CIPA REQUIREMENTS ON FCC FORM 479

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 or Basic Maintenance of Internal Connections (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 IV below.
Beginning with Funding Year 2001 (the Funding Year beginning July 1, 2001), if the Billed Entity who represents an
Administrative Authority is applying for Internet Access, Internal Connections or Basic Maintenance, the Administrative
Authority must certify on an FCC Form 479 that it is in compliance with the requirements of CIPA. If the Administrative
Authority is applying for Internet Access, Internal Connections or Basic Maintenance for the first time, and has not
completed all of the requirements for CIPA, it must certify that it is undertaking such actions to comply with the
requirements of CIPA prior to the start of the following Funding Year. (If the Administrative Authority is the Billed Entity, the
Administrative Authority will certify on the FCC Form 486.) The Billed Entity must receive your completed and signed
Forms 479 before it can complete and postmark its FCC Form 486. If the Billed Entity is applying only for
Telecommunications Services, the requirements of CIPA do not apply and the Billed Entity is not required to collect FCC
Forms 479. 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 services, CIPA compliance is required. (For more
information, see the Children's Internet Protection Act, as codified at 47 U.S.C. 254(h) and (l).)

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 only when an FCC Form 486 for a Funding Request for Internet Access,
Internal Connections or Basic Maintenance has been successfully data entered and USAC has issued an FCC Form 486
Notification Letter.

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 the

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 the first Funding Year, the applicant 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 the First Funding Year is established, the Funding Year immediately following the First Funding Year becomes the

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.
The

Third Funding Year

for purposes of CIPA is the Funding Year immediately following the 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:
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FCC Form 479 Instructions
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OMB Control No. 3060-0853

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 Billed Entity
cancels all of its Funding Requests 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 an 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.

III.

SUBMISSION REQUIREMENTS AND GENERAL INSTRUCTIONS

Who Must Submit the FCC Form 479?

In general, the Administrative Authority is the entity that must complete the FCC Form 479. 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 the FCC Form 479, 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.

How Many FCC Forms 479 to Submit to the Billed Entity?

Generally, you will complete one FCC Form 479 for each of your Billed Entities.

When to Submit the FCC Form 479?

The Billed Entity must receive your completed and signed FCC Form(s) 479 in time to postmark the Billed Entity's FCC
Form 486 to meet FCC Form 486 deadlines. You should work with your Billed Entity to determine when to submit your
FCC Form 479.
You must complete an FCC Form 479 for each Funding Year in which you receive discounted services beginning with
Funding Year 2001 (the Funding Year beginning July 1, 2001) and after.
SPECIAL NOTE FOR LIBRARIES AND CONSORTIA CONTAINING LIBRARIES FOR FUNDING YEAR 2003: On July 24,
2003, the FCC released an Order (FCC 03-188) to bring its implementation of CIPA into compliance with the recent United
States Supreme Court decision on CIPA.

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 6e
below.)
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FCC Form 479 Instructions
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OMB Control No. 3060-0853

If a library has applied for funds for Internet Access, Internal Connections or Basic Maintenance in both Funding
Year 2003 and Funding Year 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 to Send FCC Form 479?

DO NOT SUBMIT THE COMPLETED FCC FORM 479 TO THE SCHOOLS AND LIBRARIES DIVISION OF THE
UNIVERSAL SERVICE ADMINISTRATIVE COMPANY OR TO THE FCC; SUBMIT IT ONLY TO YOUR BILLED
ENTITY.

Compliance.

Anyone filing false information is subject to penalties for false statements, including 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.
All of the information required in the FCC Form 479 must be completed in order for the Billed Entity to be able to certify as
required on the FCC Form 486.

Where to Get More Information?

Information is available on the USAC website at http://www.usac.org/sl" title="www.usac.org/sl">www.usac.org/sl. Information is also available by contacting the SLD
Client Service Bureau by email using the "Submit a Question" feature on the USAC website, by fax at 1-888-276-8736 or
by phone at 1-888-203-8100.

IV.

SPECIFIC INSTRUCTIONS

Type or clearly print in the spaces provided. Attach additional pages if necessary.

Administrative Authority's Form Identifier:

Use this space to assign a number or letter of your own devising to facilitate
communication with your Billed Entity about THIS particular FCC Form 479. Your Administrative Authority's Form Identifier
can be very simple; for example, if you are filing three FCC Forms 479, you might label them "A," "B," and "C." The
Administrative Authority's Form Identifier can also be descriptive, such as "Internet." Choose identifiers that suit your own
record keeping needs.

A.

Block 1: Administrative Authority Information

Block 1 of FCC Form 479 asks you for your name, address, and basic identification information.

Item 1

- Provide the name of the Administrative Authority.

Item 2

- Provide the Funding Year (e.g., 20012002) for which funds were requested or approved and for which the Billed
Entity will be submitting an FCC Form 486. Program Funding Years begin on July 1 and end on June 30. For example,
Funding Year 2001 runs from July 1, 2001 through June 30, 2002. Cite only one Funding Year in this item.

Item 3

- Provide the Administrative Authority's full mailing address, whether a street address, Post Office Box number, or
route number. Provide the Contact Person's Name; telephone number including the area code; fax number; and e-mail
address.

B.

Block 2: Certifications and Signature

Block 2 of FCC Form 479 asks you to certify with respect to your status as the Administrative Authority and with respect to
your compliance with the Children's Internet Protection Act.
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FCC Form 479 Instructions
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OMB Control No. 3060-0853

Item 4

Certify that you are an Administrative Authority for one or more schools or libraries for which Universal Service
Support Mechanism discounts have been requested or approved for eligible services. You must make the required
certification(s) for the purposes of the Children's Internet Protection Act in order to receive discounted services. While the
Billed Entity will not submit the FCC Form 486 until after discount requests have been approved and a Funding
Commitment Decision Letter (FCDL) has been issued, the Billed Entity may ask you to file the FCC Form 479 in advance
of approval of the requests so that the Billed Entity is ready to file the FCC Form 486 once the FCDL has been received.

Item 5

Certify to your recognition that you may be audited pursuant to this certification and will retain for at least five
years (or whatever retention period is required by the rules in effect at the time of this certification) any and all records that
you rely upon to complete this form.

Item 6

- 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. Check the box that describes
the status of compliance with the Children's Internet Protection Act. The certification statements in Item 6 of the FCC
Form 479 should be read as if you are addressing them to the Billed Entity.
An Administrative Authority can certify Item 6b only in the first Funding Year after Funding Year 2000 (the Funding Year
beginning July 1, 2000) for which it is applying for discounts for Internet Access, Internal Connections or Basic
Maintenance services. An Administrative Authority can seek a CIPA Waiver under Item 6d only in its Second Funding
Year. If you request a CIPA Waiver, you certify that your schools or libraries will be in compliance before the start of the
Third Funding Year. You cannot seek a CIPA Waiver in your Third Funding Year, even if you have a new school or library
branch/outlet under your authority in that Funding Year. (See "Impact of CIPA Requirements on FCC Form 479" above
for a discussion of First, Second and Third Funding Years.)
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
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 will also be 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.
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FCC Form 479 Instructions
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OMB Control No. 3060-0853
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 6a

Check here if you certify to the Billed Entity that the recipient(s) of service under your administrative authority
and represented in the Funding Request Number(s) for which the Billed Entity has requested Funding Commitments
has (have) complied with the requirements of the Children's Internet Protection Act.

Item 6b

Check here if you certify to the Billed Entity that the recipient(s) of service under your administrative
authority and represented in the Funding Request Number(s) for which the Billed Entity has requested Funding
Commitments is (are) in its (their) first funding year for purposes of CIPA and is undertaking such actions, including
any necessary procurement procedures, to comply with the requirements of the Children's Internet Protection Act for
the next funding year, but has (have) not completed all requirements of CIPA for this funding year.

Item 6c

Check here if you certify that the Children's Internet Protection Act does not apply because the recipient(s)
of service under your administrative authority and represented in the Funding Request Number(s) for which the Billed
Entity has requested or received Funding Commitments is (are) receiving services at discount rates 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).

Item 6d CIPA Waiver. This item is applicable only to your Second Funding Year. (See "Impact of CIPA
Requirements on FCC Form 479" above for the definition of your Second Funding Year.)

Check here if you are
providing notification that, as of the date of the start of discounted services, you are unable to make the certifications
required by the Children's Internet Protection Act because your state or local procurement rules or regulations or
competitive bidding requirements prevent the making of the certifications otherwise required. You certify that the
recipients(s) of service under your administrative authority and represented in the Funding Request Number(s) for
which your Billed Entity has requested or received Funding Commitments will be brought into compliance with the
CIPA requirements before the start of the Third Funding Year in which they apply for discounts.
For example, if in Funding Year 2001 you certify that you are undertaking such actions necessary to put the measures
required by CIPA in place for Funding Year 2002, then in order to obtain discounts in Funding Year 2002, you must
fully implement the measures prior to the start of services in that Funding Year, unless you obtain a waiver as a result
of procurement/competitive bidding constraints. Libraries must also check Item 6d if they need to request this waiver
from CIPA requirements for Funding Year 2004.

NOTE

THAT the certification language in the FCC Form 479 is not intended to fully set forth or explain all the
requirements of CIPA.

Item 7

requires the signature of the Authorized Person.

Item 8 -

Enter the date the FCC Form 479 was signed. This date must include the month, day and year.

Item 9 -

Print the name of the Authorized Person whose signature is provided in Item 7.

Item 10 -

Provide the title or position of the Authorized Person whose signature is provided in Item 7.

Item 11 -

Provide the telephone number, including area code, of the Authorized Person whose signature is provided in
Item 7. This information is required in order to expedite any communications that may be necessary between the
Authorized Person responsible for signing the FCC Form 479 and the Billed Entity.
Submit completed forms to your Billed Entity. DO NOT SUBMIT THIS FORM TO USAC OR TO THE FCC.
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FCC Form 479 Instructions
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