Supplemental Funding Request/ Annual Access Line Update Form - Kansas
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Kansas Universal Service Fund
Supplemental Funding Request/
Annual Access Line Update
Use this form to:
1. Provide Annual Access Line Update data (as of September 30, of the current year)-all
LECs/designated ETCs.
2. Request supplemental KUSF funding (for the quarters ended March 31, June 30, Sept. 30, and Dec.
31 of the current year or a minimum 2% net increase in supported lines)-all LECs and designated ETCs.
See the “LEC Access Line Guidelines” for additional information.
Company Code: KS-
Company Name:
Contact Name:
Contact Phone: ______ ____
_____
Fax: ___________________
E-Mail:_ ____________________ ___ __ _
Street:
City/State/Zip: ____ _____ _ ______
Company Officer/Agent Name:________________
_
Signature: ______________
_____ ____
Submission for Quarter-ended:
Submission Date:____
____
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