In an era where the allocation of universal service funds plays a crucial role in bridging educational and information gaps, the 473 form, officially known as the Service Provider Annual Certification Form, stands as a critical document within the framework of the Universal Service for Schools and Libraries Program. This form, governed by stringent guidelines under the Office of Management and Budget (OMB) with Control No. 3060 – 0856, serves as a pivotal step for service providers to officially certify their compliance and eligibility to participate in the funding program designed to support schools and libraries. The form is meticulously structured to collect comprehensive data from service providers, covering aspects from basic identification and contact information to detailed certifications that affirm the provider's compliance with the regulations stipulated by the Federal Communications Commission (FCC). Such certifications encompass the accuracy of data submitted, adherence to pricing regulations, prohibition of unauthorized kickbacks, and the maintenance of necessary documentation for audit purposes. Additionally, the form underscores the legal implications of submission, including penalties for perjury and the requirement to retain records for a specified period to facilitate potential audits, thereby ensuring transparency, accountability, and integrity in the provisioning of universally funded services to educational and library institutions. The thorough process outlined by this form not only underlines the FCC’s commitment to lawful and ethical distribution of funds but also emphasizes the collaborative responsibility of service providers in advancing educational equity through technological access.
| Question | Answer |
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| Form Name | Form 473 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | offeror, 1995, 2007, who fills out fcc form 473 |
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Approved by OMB |
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OMB Control No. 3060 – 0856 |
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FCC Form 473 |
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OMB Control No. 3060 – 0856 |
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Estimated time per response: 1.0 hour |
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Universal Service for Schools and Libraries
Service Provider Annual Certification Form
Please read instructions before completing. |
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(To be completed by Service Provider) |
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Block 1: Service Provider Information |
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1. Name of Service Provider |
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Service Provider Identification Number (SPIN) |
3. Funding Year: |
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July 1, _________ through June 30,_________ |
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Contact Name |
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Complete Mailing Address of Contact Person |
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Street Address, P. O. Box or Route Number |
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State |
Zip Code |
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6. Telephone Number with Area Code |
7. Fax Number with Area Code |
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_____ - _____ - ___________________ |
_____ - _____ - _______________ |
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Email Address |
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Block 2: Certification
I declare under penalty of perjury that the foregoing is true and correct:
I am authorized to submit this Service Provider Annual Certification Form on behalf of the
9.I certify that the Service Provider Invoice Forms (FCC Form 474) that are submitted by this Service Provider contain requests for universal service support for services which have been billed to the Service Provider’s customers on behalf of schools, libraries, and consortia of those entities, as deemed eligible for universal service support by the fund administrator.
10.I certify that the Service Provider Invoice Forms (FCC Form 474) that are submitted by this Service Provider are based on bills or invoices issued by the service provider to the Service Provider’s customers on behalf of schools, libraries, and consortia of those entities as deemed eligible for universal service support by the fund administrator, and exclude any charges previously invoiced to the fund administrator for which the fund administrator has not yet issued a reimbursement decision.
11.I certify that any requests for reimbursement that are sought under a Service Provider Invoice Form (FCC Form 474) for discounts for products or services that contain both eligible and ineligible components are properly allocated as required by the Commission’s rules at 47 C.F.R. § 54.504(e) (1) and (2).
12.I certify that this Service Provider makes available to customers, upon their request, separate prices for distinct services to assist Billed Entity Applicants in identifying the portions of their bills that represent the costs of services provided to eligible entities for eligible purposes.
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FCC Form 473 |
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OMB Control No. 3060 – 0856
Service Provider Name _______________________________________________________________________________
SPIN _______________________________________________________
Contact Name ______________________________________________________________________________________
Contact Telephone Number _____ - _____ - _______________
Block 2: Certification (Continued)
13.I certify that no
14.I certify that no kickbacks, as defined in 41 U.S.C. § 8701, were paid by this Service Provider to anyone in connection with the schools and libraries universal support program.
15.I certify that this Service Provider is in compliance with the Commission’s rule and orders regarding gifts and this Service Provider and has not directly or indirectly offered or provided any gifts, gratuities, favors, entertainment, loans, or any other thing of value to any eligible schools, libraries, or consortium that includes eligible schools or libraries, except as permitted by the Commission’s rule at 47 C.F.R. § 54.503(d).
16.I certify that if the Fund Administrator, as necessary, requests additional supporting information, this Service Provider will make all documents requested available to the Fund Administrator as required by 47 C.F.R. § 54.516(b). I certify that this Service Provider will retain for at least five years (or whatever retention period is required by the rules in effect at the time of this certification), after the last day of delivery of discounted services, (1) any and all records that I rely upon to complete this form and each Service Provider Invoice Form (FCC Form 474) that is submitted by this Service Provider during the present funding year and (2) all documents necessary to demonstrate compliance with the statutory or regulatory requirements for the schools and libraries universal service support program as required by 47 C.F.R. § 54.516(a)(2) I recognize that this Service Provider may be audited pursuant to 47 C.F.R. § 54.516(c), and that the Service Provider must provide such records as required by 47 C.F.R. § 54.516(b)
17.I certify that the prices in any offer that this Service Provider makes pursuant to the schools and libraries universal service support program have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other offeror or competitor relating to (i) those prices, (ii) the intention to submit an offer, or (iii) the methods or factors used to calculate the prices offered.
18.I certify that the prices in any offer that this Service Provider makes pursuant to the schools and libraries universal service support program will not be knowingly disclosed by this Service Provider, directly or indirectly, to any other offeror or competitor before bid opening (in the case of a sealed bid solicitation) or contract award (in the case of a negotiated solicitation) unless otherwise required by law.
19.I certify that no attempt will be made by this Service Provider to induce any other concern to submit or not to submit an offer for the purpose of restricting competition.
20.I certify that this Service Provider is not suspended or debarred from participating in Federal programs.
21.I certify that, in addition to the foregoing, this Service Provider is in compliance with the rules and orders governing the schools and libraries universal service support program, and acknowledges that failure to be in compliance and remain in compliance with those rules and orders may result in the denial of discount funding and/or cancellation of funding commitments. I acknowledge that failure to comply with the rules and orders governing the schools and libraries universal service support program could result in civil or criminal prosecution by law enforcement authorities.
22. Signature of authorized person
23. Date
24. Printed name of authorized person
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OMB Control No. 3060 – 0856
25.Title or position of authorized person
26.Telephone number of authorized person
27.Address of authorized person
FCC NOTICE FOR INDIVIDUALS REQUIRED BY THE PRIVACY ACT AND THE PAPERWORK REDUCTION ACT
Part 54 of the Commission’s Rules authorizes the FCC to collect the information on this form. Failure to provide all requested information will delay the processing of the application or result in the application being returned without action. Information requested by this form will be available for public inspection. Your response is required to obtain the requested authorization.
The public reporting for this collection of information is estimated to be 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the required data, and completing and reviewing the collection of information. If you have any comments on this burden estimate, or how we can improve the collection and reduce the burden it causes you, please write to the Federal Communications Commission,
Remember – You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control number of
THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW
A paper copy of this form, with signature in Block 2, Item 24 should be mailed to:
SLD FCC Form 473
P. O. Box 7026
Lawrence, Kansas
If sent by express delivery services or U.S. Postal Service, Return Receipt Requested, the form should be mailed to:
SLD Forms
ATTN: FCC Form 473
3833 Greenway Drive Lawrence, Kansas 66046 Phone:
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