Fcc Form 486 - Schools And Libraries Universal Service Receipt Of Service Confirmation And Children'S Internet Protection Act And Technology Plan Certification Form
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7FCC Form 486
Do Not Write in this Area
OMB Control No.
DO NOT STAPLE
3060-0853
Estimated time
per response: 1.5 hours
Schools and Libraries Universal Service
Receipt of Service Confirmation and Children’s Internet Protection Act and Technology Plan Certification
Form
To be completed by the Billed Entity
Please read instructions before completing.
(You can also file online.)
Applicant’s Form Identifier
FCC Form 486 Application#: ______________
(Create your own code to identify THIS FCC Form 486)
(To be assigned by administrator)
Block 1: Billed Entity Information
1. Name of Billed Entity
2.aBilled Entity Number
3. Funding Year July 1, ________ through June 30, __________
4. Complete Mailing Address of Billed Entity
Street Address, P.O. Box, or Route Number
City
State
Zip Code
Telephone Number
Extension
Fax Number
5. Contact Person Information
Contact Person Name
Street Address, P.O. Box or Route Number
City
State
Zip Code
Check the box next to the preferred mode of contact. (At least one box MUST be checked.)
Telephone Number
Extension
Fax Number
Email Address
Page 1 of 7
FCC Form 486
December 2013
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Parent category: Business