Instructions For Fcc Form 499-Q - Telecommunications Reporting Worksheet

Reporting entities have the opportunity to enter data, verify, submit and certify FCC Forms 499-A and

499-Q online via a web-based data entry system. Company officers, who have previously filed a signed

paper form, may certify subsequent forms online without being required to submit signed paper forms.

For those officers, an electronic signature in the signature block of each form certified by that officer will

be considered the equivalent to a handwritten signature on the form. By entering his or her electronic

signature into the signature block of each form, the officer, therefore, acknowledges that such electronic

signature certifies his or her identity and attests under penalty of perjury as to the truth and accuracy of

the information contained in each electronically signed form. Visit

for more information and access to the online filing system.

A person who willfully makes false statements on the Worksheet can be punished by fine or imprisonment

under title 18 of the United States Code.

Line 127 – Indicate whether this filing is an original filing or a revised filing.

IV.

Additional Information

Reminders



Filers are required to maintain records and documentation to justify information reported on the

Telecommunications Reporting Worksheet for five years. Filers also must maintain records

detailing the methodology used to determine projections reported on the Telecommunications

Reporting Worksheet. Upon request, filers may be required to provide such records and

documentation to the Commission or to the administrator.



Is the filer affiliated with another telecommunications provider? Each legal entity must file

separately unless they qualify for filing on a consolidated basis. See section II-B. Each affiliate or

subsidiary must show the Affiliate Filers Name on Line 105.



For information on filing electronically, go to



Provide data for all lines that apply. Show a zero for services for which the contributor had no

revenues for the filing period.



Contributors to universal service support mechanisms must make five FCC Form 499 filings each

year. See Figure 2.



Wherever possible, revenue information should be taken from the contributors' financial records.

Filers also must provide projected revenue information on Line 119 through Line 120.



The Worksheet must be signed by an officer of the reporting entity. An officer is a person who

occupies a position specified in the corporate by laws (or partnership agreement), and would

typically be president, vice president for operations, comptroller, treasurer, or a comparable

position.



Do not mail the Worksheet to the FCC. See section II-C for filing instructions.



Note that FCC Form 499 is one of several forms that telecommunications carriers and other

providers of interstate telecommunications may need to file. Information concerning common

filing requirements for such providers may be found on the FCC web site, at

See 18 U.S.C. § 1001.

See section II-E.

Instructions For Fcc Form 499-Q - Telecommunications Reporting Worksheet - 2017 Page 20

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