Nebraska Usf & E911 Remittance Worksheet - Nebraska Universal Service Fund
ADVERTISEMENT
1Nebraska USF & E911 Remittance Worksheet
COMPANY IDENTIFICATION
COMPANY:
CONTACT NAME:
PHONE #:
CHECK HERE FOR THE NEBRASKA STATE TREASURER TO INITIATE YOUR ELECTRONIC FUND TRANSFER
UNIVERSAL SERVICE FUND
COMPANY NUSF CODES
DESCRIPTION
FCC FORM
REVENUES
NE
NE
1. FIXED LOCAL EXCHANGE SERVICE
499-A, Ln 404
$
NE
NE
2. FIXED LOCAL PRIVATE LINE SERVICE
499-A, Ln 406
$
NE
NE
3. OTHER FIXED LOCAL SERVICE REVENUE
499-A, Ln 408
$
4. MOBILE MONTHLY ACTIVATION CHARGES
499-A, Ln 409
$
SUBMISSION DATE
5. MOBILE USAGE CHARGES
499-A, Ln 410
$
6. PREPAID TOLL CALLING SERVICES
499-A, Ln 411
$
7. ALT. ACCESS & DIRECTORY TOLL SERVICES
499-A, Ln 413
$
REVENUE DATA PERIOD
8. SWITCHED TOLL SERVICES
499-A, Ln 414
$
Monthly
Quarterly
9. TOLL PRIVATE LINE SERVICES
499-A, Ln 415
$
10. OTHER TOLL SERVICE REVENUE
499-A, Ln 417
$
11.
AUTHORIZED ADJUSTMENTS TO RETAIL REVENUES:
$
TYPE OF SUBMISSION
12.
TOTAL INTRASTATE RETAIL REVENUES (Sum of Line 1-11):
$
Original
Revision
13.
AUTHORIZED ADJUSTMENTS TO NUSF ASSESSMENT:
$
14.
NUSF ASSESSMENT ([Line 12 x 6.95%] + Line 13):
$
WIRELESS ENHANCED 911
DATA PERIOD
LINES SERVED
LINES COLLECTED
REVENUES
$
CHANGE IN INFORMATION (PLEASE PROVIDE ONLY THE INFORMATION THAT HAS CHANGED)
COMPANY NAME:
CONTACT NAME:
PHONE #:
E-MAIL ADDRESS:
FAX #:
ADDRESS:
CITY:
STATE:
ZIP:
CERTIFICATION
Date
Agent Name
Agent Title
Agent Signature
Return Form to: Nebraska Universal Service Fund
Questions? Jeff Pursley, NUSF Director
NOTE: ALL PAYMENTS MUST BE
Post Office Box 94927
Phone: Phone: (402) 471-0264
TRANSFERRED ELECTRONICALLY
jpursley@mail.state.ne.us
Lincoln, NE 68509-4927
E-Mail:
TO NEBRASKA STATE TREASURER.
or Fax to: (402) 471-0214
Website: http:/
REV. 8/8/2001
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal