Form Boe-501-Tea - Emergency Telephone Users Surcharge-Exempt Interstate Revenue Election Form
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1BOE-501-TEA REV. 1 (11-12)
STATE OF CALIFORNIA
EMERGENCY TELEPHONE USERS SURCHARGE—EXEMPT INTERSTATE
BOARD OF EQUALIZATION
REVENUE ELECTION FORM
Please read the instructions below before preparing this schedule.
ACCOUNT NUMBER
A
B
C
TYPE OF
METHOD OF CALCULATING CHARGES NOT SUBJECT
ELECTION DATE
SERVICE
TO THE SURCHARGE
Books and records used in course of business.
Traffic or call pattern studies of service provided to customers within
California. Interstate percentage used.
%
(The studies shall be maintained and made available for review upon
request by the BOE.)
For Voice Over Internet Protocol (VoIP) service only.
FCC Safe Harbor factor effective September 1st of previous year.
Factor used:
Note: Service suppliers who do not submit an election are required to report using the books and records
method.
GENERAL
The Emergency Telephone Users (911) Surcharge Law imposes a surcharge upon every service user of intrastate tele-
phone communication service in this state, commencing on July 1, 1977. Every service supplier (or billing aggregator
authorized by a service supplier), including VoIP service suppliers, is required to collect the 911 surcharge from the
service user in its normal billing for services. A service supplier is permitted to choose between two (or three for a
VoIP service supplier) optional methods of calculating the interstate portion of its charges. For each type of service
supplied by the service provider, an election must be made at least once for one of the optional methods. This
election will remain in force for at least one calendar year (January 1 to December 31) before the service supplier
can make a change in the election. The election does not need to be renewed; it will remain in effect until the service
supplier elects another method by submitting a new BOE-501-TEA, until a change occurs in the traffic or call pattern
interstate percentage, or until the Board of Equalization (BOE) requests an updated form.
Mail your completed form to:
Appeals and Data Analysis Branch, MIC:33, State Board of Equalization, PO Box 942879, Sacramento,
CA 94279-0033
INSTRUCTIONS
Column A. Type of Service. Enter the type of service or services you provide, for example, landline, wireless, or
VoIP, on the line for the method of calculation you are electing to use to report taxable service charges for
that service.
Column B. Method of Calculating. Calculation methods available. (See note below for VoIP.)
Column C. Election Date. Any method chosen by a service supplier shall remain in effect for at least one calendar
year (January 1 to December 31) from the election date.
For VoIP service only. The VoIP Safe Harbor factor is established by the FCC for determining a service supplier’s
interstate revenue for purposes of calculating the service supplier’s contribution to the Federal Universal Service Fund.
The FCC Safe Harbor factor in effect for VoIP service on September 1st of each year shall apply for the following
calendar year for purposes of this method of calculation. Should the FCC establish a Safe Harbor factor for calculat-
ing VoIP service supplier’s interstate revenue that is greater than 75 percent or abolish the VoIP Safe Harbor factor
entirely, this method of calculation will become invalid, in which case an alternative method approved in advance by
the BOE, shall be available to all VoIP service suppliers.
PRINT NAME AND TITLE
SIGNATURE
TELEPHONE NUMBER
(
)
COMPANY NAME
EMAIL ADDRESS
DATE
CLEAR
PRINT
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