HCF Program Forms Forms Enhancements List. New fields added to the Forms 460, 461, and 462. universalservice.org

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1 2017 Forms Enhancements List HCF Program Forms New fields added to the Forms 460, 461, and 462 Form 460 Form Nickname -- This optional field was added to the Site Information tab for individual HCPs and the Consortium Information tab for consortia. HCP & Legal Entity Website -- These two optional fields were added to the Site Information tab for individual HCPs. Title/Position, Employer s FCC Registration Number -- These two mandatory fields were added to the Contact information tab and will be collected for all primary and secondary account holders added via a Form 460. Employer Website -- This optional field was added to all primary and secondary account holder fields in the Contact Information tab. Authorized Person s Address -- These mandatory address fields were added to the Signature page. These fields will pre-populate if the authorized person already has an address on file with USAC. Form 461 Geolocation -- This read-only field was added to the General Information for individual HCPs tab so that service providers can also see geolocation information provided on a site s latest approved Form 460 during the bid posting period. Bid Contact Address -- These mandatory address fields are being added to the bid contact fields on Line 13a for individual HCPs and Line 19 for consortia in order to provide more contact information to interested service providers during the competitive bidding period. Bid Contact Fax Number -- This optional field is also added to the Bid Contact fields to provide service providers with more contact methods during the competitive bidding period. Phone # and Address of Contact Who Assisted -- These two fields will now be collected whenever an applicant provides USAC with the information for consultants that may have helped prepare bidding information. Form 462 Service Provider Selection Date -- This mandatory field was added to the Competitive Bidding Information tab of all Forms 462 that are created following a Form 461 posting. Evergreen Contract Review -- This is a yes/no question that will be asked in the Expense Items tab whenever a contract is uploaded. This is for the applicant to indicate if they would like the attached contract to be reviewed for evergreen status. Newly Installed Circuit -- This optional yes/no question will be asked of each expense item on a Form 462 to indicate if that particular circuit represents a newly installed service.

2 In addition to the new fields: Updated Form PDFs -- The PDF version of the Forms 460, 461, and 462 have been updated in order to include the new information now being collected on the forms. Updated Network Cost Worksheet (NCW) -- The NCW template on multi-expense and consortia Forms 462 has been updated to include the two new yes/no questions asked on the Expense Items tab (evergreen review and newly installed circuit). Skilled Nursing Facilities -- Skilled Nursing Facility will now be an available option in the dropdown of eligible HCP types on Form 460 for individual HCPs, and will also appear on the updated PDF of the Form 460. Supporting Documentation Tab -- A new tab was added to the Form 460 for applicants to provide any documentation that might support their eligibility determination request. Providing this supporting documentation is optional.

3 Telecom Program Forms New fields added to the Forms 465 and 466 Form 465 Tab: HCP Location Information Legal Entity Name -- This is a new mandatory field for the name of the legal entity that owns or governs the HCP. Contact Employer -- This is a new mandatory field for the employer name of the physical location contact. Title -- This is a new mandatory field for the title of the physical location contact. Tab: Eligibility Brief Explanation of Why Site Qualifies as the Organization Type Selected -- This optional field is where the applicant can explain why they believe their HCP qualifies as the type of HCP that they selected in the HCP Type dropdown field (which appears just above this new field). Tribal affiliation -- This is a new mandatory field where the applicant will select from four options that describe the HCP s tribal affiliation. Line This field is being removed and replaced in by the Anticipated Application(s) and Use(s) of the Supported Connection checkboxes that will now appear on the Request for Services tab. Tab: Additional Information (new tab) Employer Identification Number (EIN) -- This mandatory field is where the applicant will enter the HCP s EIN. National Provider Identifier (NPI) -- This field is mandatory unless the applicant enters information for the Explanation if no NPI field. When filing for medical institutions, applicants should enter the organization s NPI here. Explanation if no NPI -- This field is mandatory if the applicant did not enter data for the National Provider Identifier (NPI) field. Organization Taxonomy Code -- This is a mandatory field where the applicant will enter the HCP organization s Taxonomy Code. Site Taxonomy Code -- This field is mandatory unless the applicant enters information Explanation if no site Taxonomy Code field. Explanation if no site Taxonomy Code -- This field is mandatory if the applicant did not enter data for the Site Taxonomy Code field. Tab: Request for Services Requested Contract Period -- This mandatory field was added for the HCP s desired contract length (free text). Number of Days USAC Should Post -- This field will be read only and will display 28.

4 Posting End Date -- This is a read only field will read 28 days after posting. Expected Bid Evaluation Period (days) -- This is required free text field for the time that the HCP expects to spend reviewing bids after the posting end date. Anticipated Application(s) and Use(s) of the Supported Connection -- This line allows the applicant to describe the requested services by checking off anticipated usage types and indicating usage levels and periods for each. This is nearly an identical port of the checkboxes that appear on the HCF side. Tab: Bid Evaluation (new tab) Bid Evaluation -- On this new mandatory section, applications will select criteria that the HCP will use when reviewing service provider bids. Each criteria selected must include a weight (%), and the sum of all weights must equal 100%. Tab: Declaration of Assistance (new tab) Declaration of Assistance -- This new optional field allows the applicant to enter the contact information of an individual who assisted in preparing the form 465. Multiple contacts may be added. Form 466 Tab: Bill Payer Information Billed Entity Contact Employer -- This mandatory field has been added for the applicant to enter the employer of the billed entity contact. County -- In this new mandatory field, the applicant now include county information when providing the address of the billed entity contact. Tab: Service Information Line 33 Actual Rural Rate per Month -- The input for this field is being modified. Rather than simply entering a single value, that may or may not include taxes and fees, the form will now clearly collect both pre and post-taxes and fees values, the sum of which will represent the Actual Rural Rate per Month. To achieve this, the traditional line 33 field was removed and three new fields were added: o Undiscounted Cost per Month (excluding taxes & fees) -- This mandatory field will capture the service provider s rural rate without consideration for taxes and fees. o Taxes and Fees per Month -- An optional field, here the applicant may enter valid taxes and fees related to the rural rate expense. o Total Undiscounted Cost per Month -- This is a read only field, it will display the sum of the two fields above. Tab: Rates/Bids (For a mileage-based Form 466) Line 37 Monthly Mileage Charges (Exclude Channel Termination Charges, etc.) -- The input for this field is being modified. Rather than collecting a single value that may or may not include taxes and fees, the form will now clearly collect both pre and post-taxes and fees values, the sum of which will

5 represent the Monthly Mileage Charges. To achieve this, the traditional line 37 field was removed and three new fields were added: o Monthly Mileage Charges (excluding taxes & fees) -- This required field will capture the monthly mileage charges rate without consideration for taxes and fees. o Monthly Taxes and Fees -- An optional field, here the applicant may enter valid taxes and fees related to the monthly mileage charges. o Total Monthly Mileage Charges -- This is a read only field that will display the sum of the monthly mileage charges and monthly taxes and fees above. (For a rate comparison Form 466) Line 41 Monthly Urban Rate (in selected Large City) -- The input for this field is being modified. Rather than collecting a single value that may or may not include taxes and fees, the form will now clearly collect both pre and post-taxes and fees values, the sum of which will represent the Monthly Urban Rate. To achieve this, traditional line 41 field was removed and three new fields were added: o Monthly Urban Rate (excluding taxes & fees) -- This required field will capture the urban rate without consideration for taxes and fees. o Monthly Taxes and Fees -- An optional field, here the applicant may enter valid taxes and fees related to the urban rate. o Total Monthly Urban Rate -- This is a read only field; the field will display the sum of the two above. Number of Service Providers that Bid -- A new required field, if an applicant selects yes when asked if the HCP received any bids, the number of bids received will now be collected as well. In addition to the new fields: Updated Form PDFs -- The PDF version of the Forms 465 and 466 have been updated to accommodate the new information now being collected on the forms. The Form 467 PDF will now also display the funding request number (FRN). Search Posted Services Line 29 was removed from the Form 465. This line is featured in the search posted services tool. This section will not be blank for Forms 465 submitted after January 1, Applicants can download the PDF to see the relevant information (the Anticipated Application(s) and Use(s) of the Supported Connection checkboxes) in the Form 465 addendum. Skilled Nursing Facilities -- Skilled Nursing Facility will now be an available option in the dropdown of eligible HCP types on line 27 of the Form 465. This new option will also appear on the updated PDF of the Form 465.