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Fcc Form 486 - Schools And Libraries Universal Service Receipt Of Service Confirmation And Children'S Internet Protection Act And Technology Plan Certification Form Page 2

DO NOT STAPLE

OMB Control No. 3060-0853

Entity Number __________________ Applicant’s Form Identifier ___________________________

Contact Person __________________________________ Phone Number _________________________

Block 2: Early Filing Information and CIPA Waiver Request

6a.

Early Filing

CHECK THE BOX BELOW IF THE FRNS ON THIS FCC FORM 486 ARE FOR SERVICES STARTING ON OR

BEFORE JULY 31 OF THE FUNDING YEAR.

The Funding Requests listed in Block 3 have been approved by USAC as shown in my Funding

Commitment Decision Letter (FCDL). I have confirmed with the service provider(s) featured in

those Funding Requests that these services will start on or before July 31 of the Funding Year.

Remember: Early filing using Item 6a is an option if and ONLY if services will start within the

month of July of the relevant Funding Year, all relevant certifications in Block 4 can be

accurately made, and the FCC Form 486 is postmarked on or before July 31 of the Funding

Year.

6b.

CIPA Waiver

CHECK THE BOX BELOW IF YOU ARE REQUESTING A WAIVER OF CIPA REQUIREMENTS FOR THE

SECOND FUNDING YEAR IN WHICH YOU HAVE APPLIED FOR DISCOUNTS IF YOU AS THE BILLED

ENTITY ARE THE ADMINISTRATIVE AUTHORITY.

I am providing notification that, as of the date of the start of discounted services, I am unable to

make the certifications required by the Children’s Internet Protection Act, as codified at 47 U.S.C. §

254(h) and (l), because my state or local procurement rules or regulations or competitive bidding

requirements prevent the making of the certification(s) otherwise required. I certify that the

schools or libraries represented in the Funding Request Number(s) on this FCC Form 486 will be

brought into compliance with the CIPA requirements before the start of the Third Funding Year in

which they apply for discounts.

(For Libraries for Funding Year 2004: You may also request this waiver for FY2004 if you as the

Billed Entity are the Administrative Authority for the library(ies) represented on this FCC Form 486.

By checking this box, you are certifying that the library(ies) represented in the Funding Request

Number(s) on this FCC Form 486 will be brought into compliance with the CIPA requirements

before the start of Funding Year 2005.)

Page 2 of 7

FCC Form 486

December 2013

Fcc Form 486 - Schools And Libraries Universal Service Receipt Of Service Confirmation And Children'S Internet Protection Act And Technology Plan Certification Form Page 2

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