Instructions For Fcc Form 499-Q - Telecommunications Reporting Worksheet

FCC Form 499-Q, January 2017

Approved by OMB

OMB Control Number 3060-0855

Estimated Average Burden Hours Per Response: 10 Hours

Telecommunications Reporting Worksheet, FCC Form 499-Q (2017)

Instructions for Completing the Quarterly

Worksheet for Filing Contributions

to Universal Service Support Mechanisms

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NOTICE: Sections 54.706, 54.711, and 54.713 of the Federal Communications Commission’s rules require

all telecommunications carriers providing interstate telecommunications services, interconnected voice-

over-Internet-protocol (VoIP) providers that provide interstate telecommunications, providers of interstate

telecommunications that offer interstate telecommunications for a fee on a non-common carrier basis, and

payphone providers that are aggregators to contribute to universal service and file this Telecommunications

Reporting Worksheet (FCC Form 499-Q or Worksheet) on February 1, May 1, August 1, and November 1,

each year. 47 CFR §§ 54.706, 54.711, 54.713. This collection of information stems from the Commission's

authority under Sections 151(i) and 254 of the Communications Act of 1934, as amended (Communications

Act or Act), 47 U.S.C. §§ 151(i), 254. The data in the Worksheet will be used to calculate contributions to

the universal service support mechanisms. Selected information provided in the Worksheet will be made

available to the public in a manner consistent with the Commission’s rules.

We have estimated that each response to this collection of information will take, on average, 10.0 hours.

Our estimate includes the time to read the instructions, look through existing records, gather and maintain

the required data, project growth or decline in revenues, and actually complete and review the form or

response. If you have any comments on this estimate, or how we can improve the collection and reduce the

burden it causes you, you may write the Federal Communications Commission, AMD-PERM, Washington,

D.C. 20554, Paperwork Reduction Project (3060-0855). We also will accept your comments via the

Internet if you send them to PRA@FCC.gov. DO NOT SEND COMPLETED WORKSHEETS 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 Office of Management and Budget (OMB) control number. This collection has been assigned an

OMB control number of 3060-0855.

The Commission is authorized under the Communications Act of 1934, as amended, to collect the

information we request in this form. We will use the information that you provide to determine contribution

amounts. If we believe there may be a violation or potential violation of a statute or a Commission

regulation, rule, or order, your Worksheet may be referred to the Federal, state, or local agency responsible

for investigating, prosecuting, enforcing, or implementing the statute, rule, regulation, or order. In certain

cases, the information in your Worksheet may be disclosed to the Department of Justice, court, or other

adjudicative body when (a) the Commission; or (b) any employee of the Commission; or (c) the United

States government, is a party to a proceeding before the body or has an interest in the proceeding.

With the exception of your employer identification number, if you do not provide the information we

request on the Worksheet, the Commission may consider you in violation of sections 1.47, 52.17, 52.32,

54.713, and 64.604 of the Commission's rules. 47 CFR §§ 1.47, 52.17, 52.32, 54.713, and 64.604.

The foregoing Notice is required by the Paperwork Reduction Act of 1995, P.L. No. 104-13, 44 U.S.C. §§

3501, et seq.

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Instructions For Fcc Form 499-Q - Telecommunications Reporting Worksheet - 2017

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