OUS1 Worksheet Instructions
Company Identification Number located on the top right corner is assigned by the Oregon Public Utility Commission (OPUC) and used on all correspondence with the Oregon Universal Service Fund (OUSF) Administrator.
Block 1: Telecommunications Service Provider (TSP) Identification
Line 1: List the legal name of the provider as it appears on the articles of incorporation or other legal documents. Each entity must file a separate worksheet.
Line 2: List the name the provider conducts business as, which would typically be found on customer bills or the name used when service representatives answer customer inquiries.
Line 3: List the TSP as an incumbent telecommunication utility (including a cooperative), or a competitive telecommunications service provider as defined in
OAR 860-032-0001, or as a Radio Common Carrier (RCC).
Line 4a: Check-off the principal telecommunications business of the provider, which should match the application of certification.
- Shared Tenant Service (STS) means the provision of shared telecommunications services and equipment to multi-tenant locations, as defined in OAR 860-032-0001(9).
- Local Exchange Switched Service means the provision of switched telecommunications services within the boundaries of the exchange, as filed with and approved by OPUC. For OUS purposes, this classification includes the provision of switched access and local interconnection services to other providers. See OAR 860-032-0001(4).
- Local Exchange Non-Switched Service means the provision of non-switched private line services within the boundaries of the exchange. For OUS purposes, this classification includes the provision of special access services to other providers.
- Toll Switched Service means the provision of interexchange long distance message toll services. See OAR 860-032-0001(13).
- Toll Non-Switched Service means the provision of interexchange long distance private line services.
- Operator Service means the provision of manual or automatic operator services in response to a customer’s request for special billing, dialing assistance, or information regarding the use of and charges for its telecommunications services. See OAR 860-032-0001(5).
- Cellular/PCS/CMR means radio (wireless) telecommunications used for cellular, personal communications service (PCS), and commercial mobile radio service (CMR).
- Paging/Messaging means radio telecommunications used for paging and messaging.
Line 4b: Check how the service is furnished, whether by constructed (owned) facilities, leased unbundled network elements (UNEs) from an incumbent telecommunications utility, or resale of another provider’s finished services.
Line 5: List the name of the provider’s holding company or controlling entity, if any.
Line 6: List the name of the management company if the provider is managed by an entity other than itself. The management company would typically be the point of contact for the OUSF Administrator.
Line 7: List the principal carrier identification code used for interexchange service.
Line 8: List the mailing address of the corporate headquarters of the provider.
Line 9: List a telephone number that can be used for customer inquiries.
Block 2: Contact Information
Line 10: List the name of a contact person who can provide clarification, additional information, and if necessary, serve as the first point of contact for the OUSF Administrator.
Line 11a and b: List the telephone and fax numbers of the contact person listed in line 10.
Line 12: List the email address of the contact person listed in line 10.
Line 13: Provide the complete mailing address of the contact person listed in line 10. Worksheets from the fund administrator will be mailed to this address; therefore it is critical the information is accurate and complete. If there have been changes in the information, please file a revised OUS1 Worksheet with the fund administrator as soon as possible.
Line 14: List the billing address of the provider. Financial transactions (billing or electronic fund transfers) between the fund administrator and the TSP will be sent to this address.
Block 3: Certification
Line 15: Include the signature of an officer of the company. In lieu of an officer signature, a company-designated manager may sign. The signature certifies the accuracy of the information provided to the OUSF Administrator.
Line 16: Print the name of the officer or manager.
Line 17: Include the position/title of the officer or manager.
Line 18: List the date the OUS1 form was signed.