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 range from 1 to 2 hours 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, AMD-PERM, Paperwork Reduction Act Project (3060-0853), Washington, DC 20554. We will also accept your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet if you send them to PRA@fcc.gov. PLEASE DO NOT SEND YOUR RESPONSE TO THIS FORM TO THIS ADDRESS.
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 3060-0853.
THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31, 1974, 5 U.S.C. 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.
The FCC Form 486 Receipt of Service Confirmation Form is used by the Billed Entity who filed an FCC Form 471, Services Ordered and Certification Form, on behalf of an eligible school, school district, library (outlet/branch, system), or a consortium of those entities. The Form 486 informs USAC 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 of a properly completed Form 486 by USAC triggers the process for USAC to receive and process invoices.
The Form 486 must be filed to accomplish the following:
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.
Throughout these Instructions, the Billed Entity will be referred to as "Billed Entity" or "you." A Billed Entity may be a school, school district, library (outlet/branch, system), or a consortium of those entities. A Billed Entity may also be a city, a state, or an entity created solely to participate in this universal service discount mechanism that actually pays the bills for the service to the service provider. The Billed Entity itself may or may not be eligible for discounts. The same Billed Entity that filed the Form 471 application should be identified as the Billed Entity for the Form 486. Please note that consortium leaders generally have a special requirement for Funding Year 2001 and later (see the instructions for Item 11).
You must submit the relevant information on a Form 486 for each Funding Request Number (FRN). Each FRN from Form 471, Block 5 contains information about one service for which you have requested discounts. You may have submitted multiple Block 5 requests. The FRN(s) cited on this Form 486 must be based on the FRN(s) cited in the Funding Commitment Decision Letter(s) (FCDL) issued by USAC.
Universal service support will not be paid to a service provider on an approved funding commitment prior to receipt of the Form 486. A service provider is not obliged to begin providing discounts to you UNTIL you file a properly completed Form 486 that is accepted and processed by USAC. We will send a written notification to you and to your service provider to acknowledge receipt and successful data entry of a Form 486 for each FRN for which the Service Provider Identification Number (SPIN) is listed. The service provider may invoice USAC for discounts provided pursuant to an approved FRN after receiving the written notification letter of receipt of Form 486 for the particular FRN and after the start of the Funding Year.
You may elect EITHER to receive discounts on bills, or to pay bills in full and receive retroactive reimbursement through an FCC Form 472, Billed Entity Applicant Reimbursement (BEAR) Form. You must choose only ONE method of discounts for the relevant Funding Year. Work with your service provider to verify which form of discount is available and works best for you.
The Children's Internet Protection Act (CIPA) was signed into law on December 21, 2000. In order to receive discounts for Internet Access, Internal Connections and Basic Maintenance services under the universal service support mechanism, school and library authorities must certify that they are enforcing a policy of Internet safety. The Internet safety policies must include measures to block or filter Internet access for both minors and adults to certain inappropriate matter.
Beginning with Funding Year 2001 (the Funding Year beginning July 1, 2001) schools and libraries applying for Internet Access, Internal Connections or Basic Maintenance must certify on Form 486 that they are in compliance with the requirements of CIPA or that they are undertaking such actions to comply with the requirements of CIPA prior to the start of the following funding year. Although CIPA requirements do not apply to Telecommunications Services, Billed Entities applying only for Telecommunications Services must, in general, still certify on a Form 486 that CIPA requirements do not apply. Additional information on the requirements of CIPA is posted in Step 10: Children's Internet Protection Act on the USAC website at http://www.usac.org/sl/applicants/step10/cipa.aspx. (For more information, see the Children's Internet Protection Act, as codified at 47 U.S.C. § 254(h) and (l).)
Administrative Authority: The Administrative Authority for a school or library is the entity that must make the relevant certification for purposes of CIPA. For a school, the Administrative Authority may be the school, school district, school Page 3 of 14 Form 486 Instructions April 2007 board, local educational agency, or other authority with responsibility for administration of the school. For a library, the Administrative Authority may be the library, library board, or other authority with responsibility for administration of the library.
If the Administrative Authority is also the Billed Entity, the Administrative Authority certifies on the Form 486. If the Administrative Authority is not the Billed Entity, the Administrative Authority must complete FCC Form 479, a Certification of Administrative Authority to Billed Entity of Compliance with the Children's Internet Protection Act, and submit the Form 479 to the Billed Entity. The Billed Entity then certifies on the Form 486 that it has collected duly completed and signed Form(s) 479. The Billed Entity does not need to collect Forms 479 when the Billed Entity applies only for Telecommunications Services.
Applying for Funds: For the purpose of CIPA requirements, a school or library that is a recipient of service is considered to have applied for funds in a Funding Year after a Form 486 is successfully data entered and USAC issues a Form 486 Notification Letter featuring an FRN for Internet Access, Internal Connections or Basic Maintenance.
Determination of Your First Funding Year for Purposes of CIPA: The first Funding Year after Funding Year 2000 (the Funding Year beginning July 1, 2000) in which a school or library applies for funds (i.e., in which a Form 486 is successfully data entered for Internet Access, Internal Connections or Basic Maintenance and USAC issues a Form 486 Notification Letter) is your First Funding Year for purposes of CIPA. Once your First Funding Year is established, the next two funding years will be your second and third funding years for purposes of CIPA. (See "Applying for Funds" above.) In your first Funding Year, you must be in compliance with CIPA or undertaking actions to comply with CIPA, in order to receive discounts for Internet Access, Internal Connections or Basic Maintenance services.
Once your First Funding Year is established, the Funding Year immediately following the First Funding Year becomes your Second Funding Year for purposes of CIPA. If the school or library applies for funds for Internet Access, Internal Connections or Basic Maintenance in the Second Funding Year, it must certify that it is in compliance with CIPA unless state or local procurement rules or regulations or competitive bidding requirements prevent the making of the certification otherwise required. A school or library so prevented may request a waiver for the Second Funding Year. (See the instructions for Item 6c.)
Your Third Funding Year for purposes of CIPA is the Funding Year immediately following your Second Funding Year. If the school or library applies for funds for Internet Access, Internal Connections or Basic Maintenance in the Third Funding Year, it must be in compliance with CIPA.
You must be in compliance with CIPA for any Funding Year thereafter.
The following situations WOULD constitute the Administrative Authority's First Funding Year:
The following situations WOULD NOT constitute the Administrative Authority's First Funding Year:
Who Must File the Form 486
The Billed Entity representing a school, school district, library (outlet/branch, system), or a consortium of those entities who completed and submitted the Form 471 to which this Form 486 relates, must file the Form 486 with USAC. Your FCDL from USAC cites your Billed Entity Number, which you must also record in Block 1, Item 2 of this form. If youreceived multiple FCDLs approving discounts for the same Billed Entity Number, in general you may choose to complete one Form 486 encompassing all of them (see "When, Where and How Many Forms 486 to File?" below).
When, Where, and How Many Forms 486 to File
You may file a Form 486 no earlier than the receipt of an FCDL from USAC.
The complete Form 486 – with Certification – MUST be received by USAC, submitted online or postmarked no later than 120 days after the Service Start Date featured on the Form 486 or no later than 120 days after the date of your FCDL, whichever is later, in order to receive discounts retroactively to the Service Start Date. If the Form 486 is postmarked later than the deadline, the date 120 days before the Form 486 postmark date will become the start date for discounted services on those FRNs featured on the Form 486. USAC will not provide discounts for the services rendered prior to the new start date and will reduce the funding commitment for the relevant FRN as appropriate.
For more information on when to file a Form 486 for recurring or non-recurring services, please see the Specific Instructions for Block 3, Item 7(E), Funding Year Service Stare Date, later in these instructions.
Program rules require that recurring services be delivered during the Funding Year. Funding years begin on July 1 and end on the following June 30. In general, non-recurring services must be delivered and installed between July 1 of the relevant Funding Year and September 30 following the June 30 close of that Funding Year. Invoices must be postmarked no later than 120 days after the last date to receive service or 120 days after the date of the Form 486 Notification Letter, whichever is later. However, program rules allow certain participants to receive extensions of the deadline for delivery and/or installation of non-recurring services. Rules also allow for extensions of the invoicing deadlines. In some cases, these extensions must be requested by the applicant or service provider and approved by USAC. Consult the "Schools & Libraries Deadlines" page on the website for complete information on Service Delivery and Invoice Deadlines and Extension Requests, and other Program deadlines.
Guidance on when to file in certain specific situations is provided below:
You may be eligible to file the Form 486 on or before July 31 of the Funding Year if:
This option is at the discretion of the Billed Entity; it has the merit of facilitating the provision of discounts on bills as soon as possible and means that USAC is authorized to begin payments on invoices submitted by your service provider for services delivered and installed on or after the Service Start Date.
For early filing complete your Form 486 – including the certification(s) in Items 8 and 11 – and postmark the Form 486 on or before July 31 of the Funding Year. Early filers must also check Item 6a.
If the Service Start Date featured on your Form 486 is on or before October 28, 2001 and the date of your FCDL is AFTER October 28, 2001, the Form 486 MUST be postmarked no later than 120 days after the date of your FCDL in order to receive discounts retroactively to the Service Start Date.
If the Form 486 is postmarked later than the appropriate deadline above, the Form 486 postmark date will become the start date for discounted services on those FRNs featured on the Form 486. USAC will not provide discounts for the services rendered prior to the new start date and will reduce the funding commitment for the relevant FRN as appropriate.
If you have FRNs featuring Service Start Dates occurring at different times during the Funding Year, you may decide to file multiple Forms 486 to ensure that discounts are paid back to the Service Start Dates.
Under certain conditions, you can adjust the Service Start Date previously reported on a Form 486 by filing a Form 500 Beginning with Funding Year 2001, due to CIPA, a Form 500 cannot be used to move the Service Start Date earlier in time from the adjusted Service Start Date featured on the Form 486 Notification Letter.
Please refer to the Form 500 instructions for more information.
You may complete and submit the Form 486 by using "Apply Online" on the USAC website at www.usac.org/sl. If you are filing the Form 486 online, you must also complete and submit to USAC the Block 4 Certification with the signature of the authorized person (whether online or on paper). If you have a User ID and a PIN, you are encouraged to submit your Form 486 certifications online. Check our website for information about obtaining a User ID and a PIN.
Please submit this form to:
SLD Form 486
P.O. Box 7026
Lawrence, KS 66044-7026.
For express delivery services or U.S. Postal Service, Return Receipt Requested,
mail this form to:
ATTN: Form 486
3833 Greenway Drive
Lawrence, KS 66046
Note: DO NOT FILE THIS OR ANY OTHER UNIVERSAL SERVICE FORM WITH THE FEDERAL COMMUNICATIONS COMMISSION.
Note that only one Funding Year can be featured on a Form 486.
When deciding whether to file a single Form 486 for multiple FRNs or multiple Forms 486 for separate FRNs, consider the following points:
Assistance in Completing This Form
There are several sources of assistance to guide you in completing this form. If you complete this form online on our website, you will be assisted in the process by special step-by-step instructions. Whether you file online or on paper, you are urged to consult the Reference Area of the website at www.usac.org/sl/tools/reference-area.aspx for guidance in completing this form, and for complete information on CIPA and on Invoice Deadlines and Extension Requests.
Complete Program information is also available by contacting the Schools and Libraries Client Service Bureau via email using "Submit a Question" on the website at www.slforms.universalservice.org/EMailResponse/EMail_Intro.aspx, via fax at 1-888-276-8736 or via phone at 1-888-203-8100.
Persons willfully making false statements on this form can be punished by fine or forfeiture, under the Communications Act, 47 U.S.C. §§ 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. § 1001.
You are encouraged to file and certify – if you have a User ID and PIN – your Form 486 online. The online system is designed to help you file successfully, and using the online system will ensure that your Form 486 meets Minimum Processing Standards and is data entered into our system correctly.
When a paper form is received by USAC, the form is first reviewed to make sure it complies with Minimum Processing Standards (MPS) before data entry begins. MPS are necessary in order to ensure the timely and efficient processing of properly completed forms. If a form fails to meet MPS, it will be rejected. USAC may be prevented from returning the rejected form to the sender if the form lacks essential identifying information. If you receive a returned Form 486, it is important that the corrected form be resubmitted quickly. Once the corrected form is successfully data entered, the postmark date of that corrected form will be the postmark date for purposes of the deadline. (See "When to File?" above for filing deadline requirements.)
Correct Form: Each Form 486 must be:
Complete Submission: All pages of the form must be submitted.
Billed Entity Information: In Block 1, each of the following items must be properly completed:
If both of these items are blank, and the information can't be obtained from the page headers, the Form 486 will be rejected.
Service Information: Each row of the Block 3 Service Information must, at a minimum, include:
in order to be data entered as part of the Form 486. If this information is missing, the row will not be data entered and you will be notified. If all rows of the Block 3 Service Information fail to meet these requirements, the form will be rejected.
CIPA Certification: For Funding Year 2001 and later Funding Years, Billed Entities must check at least one of the boxes labeled 11a through 11e.
Valid Certification: In Block 4, Item 12 Signature of authorized person must be completed. If Item 12 is left blank, the Form 486 will be rejected.
When Blocks 1-3 of a Form 486 are submitted online, the applicant must also (1) submit the completed Block 4 certification online with a User ID and a PIN or (2) submit the completed and signed Block 4 paper certification by mail, express delivery or U.S. Postal Service Return Receipt Requested.
You are encouraged to complete and submit this form online. Alternatively, for paper submissions, you may download a paper version of the form from the website. If you file paper copies of the form, please type or clearly print in the spaces provided and attach and label additional pages if needed.
Only one Funding Year can be featured on a Form 486.
Top of Form
The data at the top of Form 486 will help both you and USAC identify each particular Form 486 you file.
"Do Not Write In This Area" – USAC uses this space to apply a bar code to your form upon receipt, so that we can properly track and archive your form.
Applicant's Form Identifier: If you are filing more than one Form 486, please use this space to assign a unique number or letter of your own devising to facilitate communication with us about THIS particular Form 486. This Applicant's Form Identifier can be very simple; for example, if you are filing three Forms 486, you might label them "A," "B," and "C." The Applicant's Form Identifier can also be descriptive, such as "Internet." Choose identifiers that suit your own record keeping needs.
Form 486 Application Number: USAC will assign and insert your Form 486 Application Number. Leave this item blank. Top of each page after page 1: If you are filing this form on paper, please provide the Entity Number (from Item 2, below), your Applicant's Form Identifier, and name and phone number of the contact person (from Item 5, below) at the top of each page of the form in the space provided. This will help alleviate problems caused if the pages become separated.
Block 1 of Form 486 asks you for your address and basic identification information, such as (your) name, address and contact information. "You" refers to the Billed Entity – a school, school district, library (outlet/branch, system), or a consortium of those entities. A Billed Entity may also be a city, a state, or an entity created solely to participate in this Program, that actually pays the bills for the service to the service provider. The Billed Entity itself may or may not be eligible for discounts.
Item 1 - Provide the name of the Billed Entity from the corresponding FCDL.
Item 2 - Provide your Billed Entity Number as it appears on the corresponding FCDL. Please be sure to obtain this information from your FCDL, as the information may have been corrected during our review of your Form 471 application.
Item 3 – Provide the Funding Year for which your funds were approved, e.g., "07/01/2001 – 06/30/2002." The Funding Year you supply here must be the same as the Funding Year contained in your FCDL for the corresponding Form 471. Each subsequent Funding Year begins on July 1 of that year. Cite only one funding year in this item.
Item 4 – Provide your full mailing address, whether a street address, Post Office Box number, or route number. You are strongly encouraged to provide a street address rather than a Post Office Box, if possible. In addition, please provide your telephone number with area code and extension (if applicable) and fax number.
Item 5 – Provide the name of the person who should be contacted with questions about this form. The Contact Person must be able to answer questions in a timely manner regarding the information included in this form. If the contact person's mailing address, telephone number or fax number are different from the information in Item 4, provide that information here. Also provide the contact person's email address. You MUST check the preferred mode of contact and provide the contact information for your preferred mode. Wherever possible, USAC will use this mode to contact you.
Item 6a – To file Form 486 before services start, this item must be checked and the Form 486 must be received by USAC or postmarked on or before July 31 of the Funding Year. In order to file Form 486 before services start, you must meet the requirements for "EARLY FILING" explained above. (See "When, Where and How Many Forms 486 to File?) If you are submitting Form 486 after services have started, do not check this box. Item 6b – If you are a Billed Entity who is also the Administrative Authority for the purpose of CIPA, you must check Item 6b if you need to request a waiver from CIPA requirements in your Second Funding Year (see the explanation in "IMPACT OF CIPA REQUIREMENTS ON FORM 486" above).
In Item 6b you may provide notification that, as of the date of the start of discounted services, you are unable to make the certification in Item 11a because your state or local procurement rules or regulations or competitive bidding requirements prevent you from making that certification. You also certify that the schools or libraries represented in the FRN(s) on this Form 486 will be brought into compliance with the CIPA requirements before the start of the third Funding Year after April 20, 2001 in which they apply for discounts. If the Billed Entity is not the Administrative Authority, Item 6b should NOT be checked.
For example, if in Funding Year 2001 you certify that you are undertaking such actions necessary to be in compliance with the requirements of CIPA for Funding Year 2002, then in order to obtain discounts in Funding Year 2002, you must be in compliance with the requirements of CIPA prior to the start of services in that Funding Year unless you obtain a waiver as a result of procurement/competitive bidding constraints. In this example, if you obtain a waiver in Funding Year 2002, you must be in compliance with the requirements of CIPA prior to the start of Funding Year 2003.In certain situations, a Billed Entity could have some FRNs for which waivers can be requested and other FRNs for which waivers are not requested. A Form 486 with Item (6b) checked must only feature FRNs for which waivers are being requested.
NOTE FOR LIBRARIES: If Funding Year 2004 is your Second or Third Funding Year for purposes of CIPA and you check Item 6b, you are certifying that you are in compliance with the Internet safety policy and the public notice and hearing/meeting requirements and that you are undertaking actions to be in compliance with the filtering or blocking technology requirement by the third program year after April 20, 2001, or the start of Funding Year 2005, whichever is later.
Item 6c – If you are a Billed Entity who is also the Administrative Authority for the library(ies) represented on this Form 486, you must check Item 6c if you need to request a waiver from CIPA requirements for Funding Year 2004.
In Item 6c you may provide notification that, as of the date of the start of discounted services, you are unable to make the certification in Item 11a because your state or local procurement rules or regulations or competitive bidding requirements prevent you from making that certification. You also certify that the libraries represented in the FRN(s) on this Form 486 will be brought into compliance with the CIPA requirements before the start of Funding Year 2005. If the Billed Entity is not the Administrative Authority, Item 6c should NOT be checked.
Block 3 of Form 486 asks you to provide the Form 471 Application Number, the Form 471 Funding Request Number, the SPIN the Service Provider Name, and the Funding Year Service Start Date.
Item 7 – Information to complete Columns (A) – (D) will be contained in your FCDL. If you file the Form 486 online, the entries for Columns (A), (C), and (D) will be automatically populated after you complete the entry of an FRN in Column (B).
Columns (A), (B), (C), and (D)
You must provide the following information for columns (A), (B), (C), and (D). All of this information should be obtained from the FCDL issued to each Form 471 Billed Entity approved for funding.
(A) 471 Application Number;
(B) Funding Request Number (FRN) for the services to be provided;
(C) Service Provider Identification Number (SPIN),
(D) Service Provider Name
Funding Year Service Start Date: The date on which the service for each FRN started, or, in certain circumstances, is scheduled to start. This date cannot be earlier than the first day of the Funding Year (July 1). Provide this date in month, day and four-digit year (mm/dd/yyyy) format.
Funding Year Service Start Date Definition:
For recurring services (for example, Telecommunications Services, Internet Access or ongoing Basic Maintenance), the Funding Year Service Start Date may be:
In no instance can this date be earlier than July 1 of the relevant Funding Year.
For non-recurring services/products installation (for example, installation of Telecommunications Services or Internet Access or purchase of eligible Internal Connections Other than Basic Maintenance), the Funding Year Service Start Date may be:
In no instance can this date be earlier than July 1 of the relevant Funding Year.
Please remember that in order to obtain discounted services from your service provider for a particular service or group of services for which USAC approved discounts, you MUST file a Form 486 with Column (E) completed to indicate the Funding Year Service Start Date.
Item 8 – Check this box to certify that the schools and libraries listed on this Form 486 are covered by technology plans that have been approved by a state or other authorized body – a USAC-certified technology plan approver – prior to the commencement of service and that cover all 12 months of the funding year. If applicable, provide the name(s) of the organization(s) that are the USAC-certified technology plan approver(s) that approved a technology plan for any eligible entity that is receiving services covered under this Form 486. If EVERY FRN listed in the Form 486 is for basic telephone service only, enter "NONE." Each entity receiving more than basic telephone services in the FRNs listed on this Form 486 MUST be included under a technology plan that has been approved by a reviewing organization, and that organization MUST have been certified by USAC for the Funding Year referenced on the Form 486. If you have any questions about technology plan review, please check "Develop a Technology Plan" on our website.
Item 9 – Certify that the services listed on this Form 486 have been, are planned to be, or are being provided to the eligible entities identified in the Form 471 application(s) cited in this Form 486. Further certify there are signed contracts covering all of the services listed except for those services provided under tariff or on a month-to-month basis.
Item 9 also requires the individual signing on behalf of the Billed Entity to certify that he or she is authorized to submit the information contained in the Form 486 on behalf of the Billed Entity. The individual signing on behalf of the Billed Entity must certify that the information contained in Form 486 is true to the best of his or her knowledge, information and belief.
Persons knowingly making false statements on this form can be punished by fine, forfeiture, or imprisonment under federal law.
Item 10 – Certify that you understand that the discount level used for shared services is conditional, for future years, upon ensuring that the most disadvantaged schools and libraries that are treated as sharing in the services receive an appropriate share of benefits from those services. Certify that you recognize that you may be audited pursuant to this application and will retain for five years any and all records, including Forms 479 where required, that you rely upon to complete this form and, if audited, will make such records available.
Item 11 – This item concerns compliance with the requirements of the Children's Internet Protection Act (CIPA), as codified at 47 U.S.C. § 254(h) and (l), and the implementing rules as codified at 47 C.F.R. § 54.520. If this Form 486 pertains to a Funding Year prior to Funding Year 2001 (Funding Years beginning July 1, 2000 or earlier), skip Item 11 and go to Item 12. Additional information on the requirements of CIPA is posted in Step 10: Children's Internet Protection Act on the USAC website at http://www.usac.org/sl/applicants/step10/cipa.aspx.
If this Form 486 pertains to Funding Year 2001 (the Funding Year beginning July 1, 2001) or later, the recipient(s) of service represented in the FRN(s) on this Form 486 must certify the status of compliance with CIPA. If you as the Billed Entity are the Administrative Authority, you will indicate the status of compliance on the Form 486. If you as the Billed Entity represent one or more Administrative Authorities (e.g., a consortium leader), then in most cases you must collect completed and signed Forms 479, Certification by Administrative Authority to Billed Entity of Compliance with the Children's Internet Protection Act, from those Administrative Authorities who are the recipients of service so that you as the Billed Entity can make the proper certification(s) on Form 486. (You do not have to collect Forms 479 if you were funded only for Telecommunications Services.)
For Funding Year 2001 and later, Item 11 must be filled in.
General Instructions for Item 11:
Special Notes for Billed Entities Who Represent One or More Administrative Authorities:
The Administrative Authority must make a certification for purposes of CIPA. (See "IMPACT OF CIPA REQUIREMENTS ON FORM 486" above for the definition of Administrative Authority.) However, in the following cases, the Billed Entity is not the Administrative Authority and therefore must collect Forms 479 from the Administrative Authority(ies):
Following are descriptions of specific situations these Billed Entities may encounter:
A Billed Entity who is not an Administrative Authority must collect Forms 479 from the Administrative Authority of any school or library represented on its Form 486 unless it was funded only for Telecommunications Services. Typically, such Billed Entities would be consortium leaders. In the case of a Billed Entity who is the Administrative Authority for some schools and/or libraries but not for others, that Billed Entity must duly complete, sign and keep a Form 479 for each school or library for which it is the Administrative Authority unless it applied only for Telecommunications Services.
A Billed Entity who is the Administrative Authority and who also represents one or more other Administrative Authorities must make one certification in Item 11a or Item 11b or Item 11c as well as one certification in Item 11d or Item 11e.
For Funding Years after Funding Year 2001, a Billed Entity who checks Item 11d must also check Item 11f or Item 11g.
A Billed Entity who checks Item 11e is certifying that the only services for which the Billed Entity has been approved for discounts on behalf of eligible members of the consortium are Telecommunications Services. If some of the eligible recipients have applied for Internet Access, Internal Connections or Basic Maintenance outside of the Billed Entity's application(s), it is the responsibility of those entities to make the appropriate certifications for those services on separate Form(s) 486.
If two Billed Entities in a state are both state-level organizations (such as a State Department of Education and a State Information Network) and both are required to collect Forms 479 from their eligible recipients of services (such as all schools and school districts or all library outlets and libraries in the state), it is not necessary for both organizations to duplicate the collection of Forms 479. One state-level Billed Entity can assume the responsibility for collecting the Forms 479 and share the information with the other state-level Billed Entity. The second state-level Billed Entity can then check Item 11d with the understanding that "I have duly collected completed and signed Forms 479" means only that the second state-level Billed Entity has evidence that the collection was accomplished.
However, the second state-level Billed Entity must verify that all of its eligible members requesting discounts are represented in the information collected by the other state-level Billed Entity.
In order to accurately make the relevant certification(s) on the Form 486, the Billed Entity who represents one or more Administrative Authorities must receive Forms 479 from the appropriate Administrative Entities before filing Form 486.
Specific Instructions for Item 11
FOR A BILLED ENTITY WHO IS THE ADMINISTRATIVE AUTHORITY:
Check the one box in Items 11a through 11c that describes the status of compliance with CIPA.
Schools and libraries receiving Program discounts are required to have an Internet safety policy that addresses: (1) access by minors to inappropriate matter on the Internet and World Wide Web, (2) the safety and security of minors when using electronic mail, chat rooms, and other forms of direct electronic communications, (3) unauthorized access, including hacking, and other unlawful activities by minors online, (4) unauthorized disclosure, use, and dissemination of personal identification information regarding minors, and (5) measures designed to restrict minors' access to materials harmful to minors. There is also a public notice and hearing/meeting requirement. The Internet safety policy must include the use of filtering or blocking technology that protects against access, through computers with Internet access, to visual depictions that are obscene, child pornography, or (in the case of use by minors) harmful to minors.
FOR A BILLED ENTITY WHO REPRESENTS ONE OR MORE ADMINISTRATIVE AUTHORITIES:
A Billed Entity who represents one or more Administrative Authorities must make the same certification(s) below as a Billed Entity who is the lead member of a consortium. If the Billed Entity represents one or more Administrative Authorities, read "consortium" and "eligible members of the consortium" to mean "the Administrative Authorities I represent."
Check the box(es) in Item(s) 11d through 11g that pertain to your situation:
This certification language contained in the Form 486 is not intended to fully set forth or explain all the requirements of CIPA.
Item 12 requires the signature of the authorized person.
Item 13 – Provide the date the Form 486 was signed. This date must include the month, day and year.
Item 14 – Print the name of the authorized person whose signature is provided in Item 12.
Item 15 – Provide the title or position of the authorized person whose signature is provided in Item 12.
Item 16 – Provide the street address, telephone number with area code, fax number and email address of the authorized person whose signature is provided in Item 12.
Submit completed Forms 486 by mail to:
SLD Form 486
P.O. Box 7026
Lawrence, Kansas 66044-7026
For express delivery services or U.S. Postal Service, Return Receipt Requested,
send Forms 486 to:
SLD Form 486
ATTN: SLD Forms
3833 Greenway Drive
Lawrence, Kansas 66046