Form Rmt-1 - Remittance And Support Worksheet For Tusf Recipients

Texas Universal Service Fund

Form RMT-1

Page 1 of 2

Remittance and Support Worksheet For

October 2008

TUSF Recipients

Section 1 – Reporting Information

1 Company Code: TX -

Box if new

2 Submission Date:

Original

Revision

4 Revenue Data Period:

JUL

AUG

SEP

OCT

Please check only one

NOV

DEC

JAN

FEB

YEAR: _______________

Month:

MAR

APR

MAY

JUN

Section 2 – Carrier Identification

5 Company Name:

Docket # for ETP/R-ETP Status

Complete Mailing Address:

(If more than one Docket exists, attach supporting documentation as required on

Company City, ST Zip

Line 35 of RMT-1, if Docket # not listed worksheet will be returned)

Company Contact Name

Company Contact Telephone:

Company Contact Email:

6 Primary Communications Business (Please “X” primary business reported):

CLEC

CLEC (TSR Only)

ILEC

WIRELESS

Other (Explain)

Parent Company Information:

Agent Contact Information

Parent Co Name:

Agent Company Name: ________________________________________________________________

Parent Co Mailing Address:

Agent Mailing Address: ________________________________________________________________

Parent Co Contact Name

Agent Contact Name __________________________________________________________________

Parent Co Telephone ___________________________ Parent Co Email _____________________________________ Agent Telephone ___________________________ Agent Email _______________________________

Section 3 – Change in Company Status

8 New Company Name:

Previously Reported as:

Date of Change

9 Business Status:

Business Sold

Business Merged

Business Discontinued

(date)

10 Company sold to or merged with:

If new business, date operations started in Texas:

Section 4 – Gross TUSF Assessment

11 Total Taxable Telecommunications Receipts (Reported under Chapter 151 of the Texas Tax Code)…..

12 a) Interstate Receipts calculated on an actual basis

12a _________________

b) Interstate Receipts calculated using a safe harbor percentage

12b _________________

c) Total Interstate receipts (12a + 12b)

12c

13 a) Intrastate receipts calculated on an actual basis

13a

b) Receipts to which safe harbor percentage is applied

13b

c) Safe Harbor percentage as approved by PUCT in Docket No.

13c

d) Intrastate Receipts calculated using safe harbor percentage (Line 13b * Line 13c)

13d

e) Total Intrastate Receipts (13a + 13d)

13e

Rates

9/04-9/06

.0565

14 TUSF Assessment Rate

10/06 - 6/07

.05

15 Gross TUSF Assessment (Line 13e * Line 14)

7/07 - 12/08

.044

1/09 -

.034

Section 5 – Net Remittance Calculation

16 a) Base High Cost Support Amt per 26.403 (THCUSP) (attach supporting documentation listing each wire center calculation)

________________

b) Less: UNE USF Support Adjustment (provide supporting documentation)

b) -

________________

c) Less: FUSF High Cost Support Adjustment per 26.403 (provide supporting documentation)

c) -

________________

d) Net High Cost Support (16a - 16b - 16c = 16d)

16d

17 Total Small & Rural ILEC Support per 26.404 -

No. Eligible Lines Served

Serving more than one study area

Yes

No If Yes - supporting documentation needs to be provided

18 NON-TSR Companies - Total Lifeline Support per 26.412: (Maximum support per customer is $3.50)

a) Total current month Lifeline Customers

No. of Lifeline Customers

Total Monthly Lifeline Support a)

b) Total adjusted Lifeline Support or true ups and adjustments this data month

c) Total lifeline for this data period (18a + 18b = 18c)

18c

19 TSR Companies ONLY - Total Lifeline Support per 26.412: (Resale ETP's attach supporting documentation listing number of non-wholesale Lifeline Customers per ILEC)

a) Total current month Lifeline Customers

No. of Lifeline Customers

Total Monthly Lifeline Support a)

b) Total adjusted lifeline support or true ups and adjustments this data month

c)Total lifeline for this data period (19a + 19b = 19c)

19c

20 Lifeline Settlement Agreement - Order 34723 Subt.R.§26.412 (f)(1)(f)

a) AT&T Territory

# of Lifeline Customers

x Rate per Settlement Agreement ______________ =

b) Embarq Territory - Central

# of Lifeline Customers