Fcc Form 499-A - Telecommunications Reporting Worksheet - 2003
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342003 FCC Form 499-A Telecommunications Reporting Worksheet
Approval by OMB
>>> Please read instructions before completing. <<<
3060-0855
Annual Filing -- due April 1.
During the year, carriers must refile Blocks 1, 2 and 6 if there are any changes in Lines 104 or 112. See Instructions.
Block 1: Contributor Identification Information
101 Filer 499 ID [If you don't know your number, contact the administrator at (973)-560-4460.
If you are a new filer, leave blank and a Filer 499 ID will be assigned to you.]
102 Legal name of reporting entity
103 IRS employer identification number
104 Name telecommunications service provider is doing business as
105 Principal communications business [Check the one that best describes the reporting entity -- see directions. Check one box only.]
CAP/CLEC
Cellular/PCS/SMR (wireless telephony incl. by resale)
Incumbent LEC
Interexchange Carrier (IXC)
Local Reseller
Operator Service Provider (OSP)
Paging & Messaging
Payphone Service Provider
Prepaid Card
Private Service Provider
Satellite Service Provider
Shared-Tenant Service Provider / Building LEC
SMR (dispatch)
Toll Reseller
Wireless Data
If Other Local, Other Mobile or Other Toll is checked,
Other Local
Other Mobile
Other Toll
describe carrier type / services provided:
106 Holding company
(All affiliated companies must show the same name on this line.)
107 FCC Registration Number (FRN) [ https://svartifoss2.fcc.gov/cores/CoresHome.html ]
[For assistance, contact the CORES help desk at 877-480-3201 or CORES@fcc.gov]
108 Management company [if carrier is managed by another entity]
109 Complete mailing address of reporting entity
corporate headquarters
110 Complete business address for customer inquiries and complaints
[if different from address entered on Line 109]
111 Telephone number for customer complaints and inquiries
(
) -
[Toll-free number if available]
112 All trade names that you have used in the past 3 years in providing telecommunications.
This should include all names by which you are identified on customer bills.
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Use an additional sheet if necessary. Each reporting entity must provide all names used for carrier activities.
PERSONS MAKING WILLFUL FALSE STATEMENTS IN THE WORKSHEET CAN BE PUNISHED BY FINE OR IMPRISONMENT UNDER TITLE 18 OF THE UNITED STATES CODE, 18 U.S.C. §1001
FCC Form 499-A
February 2003
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