Forms Rack

E-Rate Forms for Applicants:

Form Purpose
470 Description of Services Requested and Certification Form
471 Description of Services Ordered and Certification Form
472 Billed Entity Applicant Reimbursement ("BEAR") Form
479 Certification of CIPA Compliance for Consortium Members
486 Receipt of Service Confirmation
500 Adjustment to Funding Commitment and Modification to Receipt of Service Confirmation

 

E-Rate Forms for Service Providers:

Form Purpose
473 Service Provider Annual Certification ("SPAC") Form
474 Service Provider Invoice ("SPI") Form
498 Service Provider Information Form (apply for a SPIN) - file online
499 Telecommunications Reporting Worksheet - file online

 

Sample E-Rate Letters and Worksheets:

 


FCC Form 470

Schools and libraries requesting universal service discounts must seek competitive bids using the Form 470. The entity that will negotiate with potential service providers should complete the Form 470. The Form 470 cannot be completed by a service provider who will participate in the competitive bidding process.

The S&L Special Edition News Brief of July 2, 2015 announced the availability of the revised Form 470 for FY 2016. The two most important aspects of this announcement are:

  1. The previous version of the Form 470, defaulting to FY 2015, is no longer usable.
  2. The new version can only be filed online through the new E-Rate Productivity Center (EPC) by applicants and/or their consultants who have responded to USAC’s invitational email and have properly set up their accounts (see our newsletter of July 6, 2015 for more information).

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FCC Form 471

Form 471 must be filed to request discounts on eligible services for eligible schools, libraries, and consortia of those entities. Form 471 must be filed AFTER an FCC Form 470, which must be posted on the SLD web site for at least 28 days before the Form 471 is filed. This 28-day waiting period must occur before you may execute any contracts for contracted services, as applicable; before you select your service provider for tariffed or month-to-month services; and before you submit your completed Form 471. It is possible that a Form 470 posted in a prior funding year may be used where such a form resulted in a multi-year contract.

 Each Billed Entity must file a Form 471 application. Thus, even if several billed entities together filed a single Form 470, each billed entity must file a separate Form 471.

Note: An entity is considered a “billed entity” if it is responsible for making payments directly to a service provider. An entity that receives a bill, but does not make payments to the service provider on that bill, is not a billed entity. A billed entity may or may not itself qualify for discounts under the universal service support mechanism for schools and libraries.

IMPORTANT:  Submission of this form can only be accomplished electronically.  Any forms submitted by paper will be rejected and returned to the sender.

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FCC Form 472 ("BEAR form") 

Billed Entity Applicant Reimbursement

The Billed Entity Applicant Reimbursement Form is used by the Billed Entity that received a Funding Commitment Decisions Letter from the fund administrator, Schools and Libraries Corporation (SLC), and filed a Form 486 indicating that the Billed Entity Applicant intended to submit to the SLC an invoice for reimbursement of discounts on eligible services received on or after the effective date of discounts and already paid for by the applicant.

In the case of qualified preexisting contracts, discounts may be effective as of January 1, 1998, the beginning of the first program year. In other situations, the discounts will be effective as of a date following the award of a contract that resulted from posting of a request for new services in a Form 470 application to the SLC Web Site.

Completion of the Billed Entity Applicant Reimbursement Form is mandatory unless the Billed Entity and service provider have made their own, mutually agreed-upon arrangements for reimbursement or implementation of the discounts. If such an arrangement has been mutually agreed upon, reimbursement of the discounts can be achieved by submission of a Service Provider Invoice Form to the fund administrator, following either the service provider's reimbursement to the Billed Entity Applicant or the implementation of the discounts.

The applicant should prepare and submit a Billed Entity Applicant Reimbursement Form to the fund administrator when ALL of the following conditions occur:

  1. The applicant receives a Funding Commitment Decisions Letter from the fund administrator which approves discounts for services; AND
     
  2. The applicant is already receiving or has received these services, and has already paid for the services, including the price of the discounts; AND
     
  3. The applicant has filed FCC Form 486 (Receipt of Service Confirmation Form) and entered "Yes" in Column (I) of Item 6 of the FCC Form 486 to indicate its intention to submit a Billed Entity Applicant Reimbursement Form.

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FCC Form 479

Certification of CIPA Compliance

The FCC Form 479, Certification by Administrative Authority to Billed Entity of Compliance with the Children's Internet Protection Act, provides notification to a Billed Entity by an Administrative Authority of the status of the Administrative Authority's compliance for the purposes of CIPA. The Billed Entity will then certify on its FCC Form 486, Receipt of Service Confirmation Form, that it has collected duly completed and signed Forms 479 from Administrative Authorities that the Billed Entity represents. Starting in Funding Year 2002 (the Funding Year beginning July 1, 2002), Form 479 also provides notification to the Billed Entity of a request for waiver by the Administrative Authority.

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FCC Form 486

Receipt of Service Confirmation Form

The FCC Form 486 Receipt of Service Confirmation Form is used by the Billed Entity who filed an FCC Form 471 on behalf of an eligible school, school district, library (outlet/branch, system), or a consortium of those entities. The Form 486 informs the Fund Administrator, the Schools and Libraries Division (SLD) of the Universal Service Administrative Company, when the Billed Entity and/or the eligible entities that it represents is receiving, is scheduled to receive, or has received service in the relevant Funding Year from the named Service Provider(s). Receipt by SLD of a properly completed Form 486 triggers the process for SLD to receive invoices.

The Form 486 must be filed to accomplish the following:

  • To authorize the payment of invoices from your Service Provider(s)
  • To indicate approval of technology plans (as required)
  • To indicate (starting in Funding Year 2001, which begins July 1, 2001) the state of compliance with the Children's Internet Protection Act (CIPA)(Pub. L. 106-554)

To cancel or reduce a Funding Request or to change the Contract Expiration Date reported on the Form 471, please file an FCC Form 500, Adjustment to Funding Commitment and Modification to Receipt of Service Confirmation Form. Please refer to the Form 500 instructions for more information.

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Form 500

Adjustment to Funding Commitment and Modification to Receipt of Service Confirmation

The FCC Form 500 Adjustment to Funding Commitment and Modification to Receipt of Service Confirmation Form is used by the billed entity applicant who filed a FCC Form 471 on behalf of an eligible school, library, library consortium or consortium of multiple entities, and who received a commitment of funds to inform the fund administrator, the Schools and Libraries Division (SLD) of the Universal Service Administrative Company, that it wishes to reduce the funding commitment amount on the Funding Request Number (FRN) level, or about a modification in the beginning or ending date for services received during the funding year.

The Form 500 must be filed to accomplish the following:

  • To adjust the Funding Year Service Start Date reported on a previously filed Form 486 for this Funding Year
  • To adjust the Contract Expiration Date listed on your Form 471 application for this Funding Year
  • To cancel irrevocably and totally a Funding Request Number (FRN)
  • To reduce irrevocably the amount of a Funding Request Number (FRN)

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FCC Form 473

Service Provider Annual Certification ("SPAC")

A Service Provider Annual Certification Form is required to be submitted to the fund administrator in order for a service provider to complete the procedure for submitting a Service Provider Invoice Form. The Annual Certification Form must be completed by each service provider, for each separate Service Provider Identification Number (SPIN), to confirm that the Invoice Forms submitted by each service provider are in compliance with the FCC's rules governing the schools and libraries universal service support mechanism.

A service provider is any provider of eligible services to an eligible entity — a school, school district, library, library consortium or consortia of multiple entities. A service provider must obtain a Service Provider Identification Number (SPIN) by completing FCC Form 498, Service Provider Registration Form, and submitting the completed Form 498 to the Universal Service Administrative Company (USAC). For more information about SPINs, please contact the USAC's Customer Service Bureau at 1-888-641-8722, or access its Web Site of the USAC.

Universal service support will not be paid to a service provider on an approved funding commitment prior to the fund administrator's receipt of the properly completed Form 473, Service Provider Annual Certification Form.

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FCC Form 474

Service Provider Invoice ("SPI") Form

The Service Provider Invoice Form is to be completed and submitted by a service provider that has provided discounted eligible services to eligible schools and libraries, in order to seek universal service support in the amount of the discounts. The service provider must have provided the service and given a discounted bill to the applicant prior to submitting the Service Provider Invoice Form.

The service provider may file the Service Provider Invoice Form seeking reimbursement of discounts provided pursuant to an approved FRN upon the occurrence of all of the following conditions:

  1. upon receipt of an acknowledgment from SLD that the billed entity applicant has filed a Form 486, Receipt of Services Confirmation Form;
  2. upon providing discounted, eligible services to an eligible school, school district, library, library consortium or consortium of multiple entities on or after the effective date of the discounts as set forth in SLD's acknowledgement of receipt of Form 486
  3. after billing the Form 471 recipient of a Funding Commitment Decision Letter for eligible services, showing the total prediscount amount, the discounted portion and the applicant's obligation to pay the undiscounted amount;
  4. after the service provider completes and submits its Annual Service Provider Certification Form, FCC Form 473, to SLD; and
  5. no later than 90 days after the end of the pertinent funding year service delivery period. The delivery period for recurring services is generally July 1 through June 30 of the following year; the period for non-recurring services is generally from July 1 through September 30 of the following year. See the Schools and Libraries Division's website (www.sl.universalservice.org) for specific information about invoice due dates.
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FCC Form 498
Service Provider Information Form

Who Should File the FCC Form 498?

All service providers that participate in the High Cost, Low Income, Rural Health Care, or Schools and Libraries Universal Service Support Mechanisms must file FCC Form 498 to receive disbursement payments.

Service Providers should complete an FCC Form 498 in order to:

  • Apply for a new SPIN.
  • Revise an existing FCC Form 498.
  • Consolidate, merge, or deactivate existing SPINs due to a merger, acquisition, or consolidation of companies.
  • End participation in the Federal universal service support mechanisms. High Cost and Low Income recipients must comply with 47 C.F.R. § 54.205 if relinquishing High Cost or Low Income Federal universal service support.

When and Where to File

Service providers must submit the FCC Form 498 and a signed letter of certification on company letterhead before support payments will be authorized. Please send the form and letter to:

USAC Billing and Disbursement
Attn: FCC Form 498
2000 L Street, N.W. Suite 200
Washington, DC 20036

Where to Get More Information:

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