PUBLIC UTILITIES COMMISSION OF THE STATE OF CALIFORNIA

Telecommunications Division	RESOLUTION T- 16996
Public Programs Branch	March 2, 2006

R E S O L U T I O N

RESOLUTION T-16996. Approval of the Universal Lifeline Telephone Service Enrollment Forms and a Uniform Customer Notification Notice

_________________________________________________________________

Summary

This Resolution adopts the enrollment forms for the Universal Lifeline Telephone Service (ULTS) program attached as Attachment A. Revised General Order (GO) 153 adopted in Decision (D.) 05-12-013 and the enrollment forms adopted in this Resolution shall take effect on July 1, 2006. Utilities¹ shall cease the annual re-certification for their ULTS customers whose ULTS qualification renewal dates are July 1, 2006 or after.

This resolution also adopts a uniform customer notification attached as Attachment B. This customer notification is to be sent as a bill insert by all utilities to their residential and ULTS customers other than customers of foreign exchange or farmer lines. This customer notification shall be included in monthly bills rendered from June 1, 2006 through June 30, 2006. Within 15 business days from the effective date of this Resolution, the Commission's Telecommunications Division (TD) will make available, to utilities upon request, the same uniform customer notification in the following languages: Spanish, Chinese, Korean, Japanese, Vietnamese, and Tagalog for use in utilities' mailings.

Furthermore, utilities shall suspend their annual ULTS notice in accordance with § 4.3 of the GO that is scheduled to be mailed between May 1, 2006 and April 30, 2007. Commencing May 1, 2007, utilities shall resume the GO 153 § 4.3 requirement in accordance with their own established mailing schedule with a new notice containing information about the new ULTS program.

Background

D.05-12-013 amended the ULTS program changing the eligibility requirement from self-certification to means-tested/income-documented. This resolution implements D.05-12-013 which states:

Ordering Paragraph 1 - The revisions to General Order (GO) 153 that appear in Appendix A to this Order, are adopted and shall become effective at a later date, determined by the Commission Resolution that adopts the final versions of the certification and verification forms.

Ordering Paragraph 2 - The Telecommunications Division (TD) shall circulate any additional changes to the certification and verification forms, as proposed by the parties, or other changes proposed by GO, CertA or the Public Advisor's Office to the service list of this proceeding for comment. We will approve those additional changes by Commission Resolution.

Discussion

Attachment A to this Resolution includes the certification and verification forms for enrollment in the ULTS program. These forms were developed through collaborative efforts of TD, the Certifying Agent (CertA),² and the Commission's Public Advisor's (PA) Office. Revised GO 153 including the enrollment forms adopted in this Resolution shall take effect on July 1, 2006, i.e. beginning July 1, 2006, utilities shall follow the procedures identified in Revised GO 153 in enrolling ULTS customers.

Utilities shall cease the annual re-certification for their ULTS customers whose ULTS qualification renewal dates are July 1, 2006 or after. This function will be assumed by the CertA.

Pursuant to D.05-12-013,³ Attachment B to this resolution includes a uniform customer notification informing customers that starting July 1, 2006, ULTS eligibility criteria will be changed from self-certification to means-tested/income-documented. This customer notification likewise was developed through collaborative efforts of TD and PA. All utilities shall send this customer notification as a bill insert to their residential and ULTS customers except for customers of foreign exchange or farmer lines, in monthly bills rendered from June 1, 2006 through June 30, 2006. Within 15 business days from the effective date of this Resolution, TD will make available, to utilities upon request, the same uniform customer notification in the following languages: Spanish, Chinese, Korean, Japanese, Vietnamese, and Tagalog, for use in utilities' mailings.

GO 153 § 4.3 requires every utility to annually send to all of its residential customers, other than customers of ULTS,⁴ foreign exchange or farmer lines, a notice that contains information about the ULTS program. To minimize consumer's confusion on the changeover of the ULTS program from the existing self-certification to the new means-tested/income-documented requirement, utilities shall suspend their annual ULTS notices informing customers of the availability of existing ULTS program that are scheduled to be mailed on May 1, 2006 or after. Customers will be notified regarding the new ULTS program through the aforementioned bill insert mailings. Commencing May 1, 2007, utilities shall resume the GO 153 § 4.3 requirement in accordance with their own established mailing schedule with a new notice containing information about the new ULTS program.

Notice of Availability and Public Comments

In compliance with PU Code § 311(g), a Notice of Availability was e-mailed on January 31, 2006, to every certificated local telecommunications carriers, parties of record in R.04-12-001, and ULTS Administrative Committee members informing them that this draft resolution is available at the Commission `s website http://www.cpuc.ca.gov/static/documents/index.htm and is available for public comments. This Notice of Availability also informs parties of the availability of the conformed resolution, when adopted by the Commission, at the same website.

On February 15, 2006, Small LECs,⁵ Joint Consumers,⁶ Cox Communications (Cox),⁷ Verizon California Inc. (Verizon), and AT&T California (AT&T)⁸ filed comments, and on February 22, 2006, AT&T, Cox and Joint Consumers filed reply comments. Parties' recommendations that are technical in nature and involve minor revisions have been incorporated into the enrollment forms and the uniform customer notification. The following recommendations have been considered and are accepted:

· AT&T is permitted to send the uniform customer notification translated into Vietnamese, Chinese, Japanese, Korean and Tagalog as a direct mailer on June 2006.

AT&T asserted that its billing equipment has physical constraints in the number of bill inserts it may handle each month. Currently, AT&T is scheduled to place a bill insert pertaining to the 310/424 area code overlay in its June 2006 bills as required in D.05.-08-040. The remaining capacity in the billing equipment for June 2006 will allow AT&T to handle the uniform customer notification in English and Spanish only. Accordingly, AT&T requested that it be allowed to place the uniform customer notification translated into Vietnamese, Chinese, Japanese, Korean and Tagalog in a direct mailer, rather than as a bill insert, to be mailed in June 2006.⁹

AT&T's request is reasonable, and therefore is accepted.

· It is confirmed that utilities have the ability to alter the format and font size of the uniform customer notification.

AT&T asserted that utilities' bill inserts are not necessarily conformed to the 8.5 by 11 inch paper size as the uniform customer notification rendered in this Resolution. Therefore, AT&T requested a confirmation that utilities have the ability to alter the format and font size of the uniform customer notification. ¹⁰

AT&T's request is reasonable, and therefore it is confirmed that utilities have the ability to alter the format and font size of the uniform customer notification.

· TD shall update the ULTS income limits applicable for the period June 1, 2006 through May 31, 2007 within 15 business days from the effective date of this Resolution.

Verizon indicated that the ULTS income limits are updated as of June 1 for each year. The income limits shown on the enrollment forms and the uniform customer notification took effect on June 1, 2005 and need to be updated prior to the mailing of the uniform customer notification in June 2005 and the implementation of the new ULTS program on July 1, 2005. ¹¹

It was TD's intent to update the ULTS income limits prior to the mailing of the uniform customer notification and the implementation of the new ULTS program. On the other hand, in order to ensure that the appropriate income limits are incorporated into these documents, TD shall update these documents with ULTS income limits applicable for the period June 1, 2006 through May 31, 2007 within 15 days from the effective date of this Resolution.

The following recommendations were considered but rejected:

· The ULTS enrollment forms should include a procedure for customers to certify eligibility for the supplementary Tribal discounts under the federal Enhanced Lifeline/Link-Up programs.¹²

Small LECs suggested that to ensure customers living in federally recognized Tribal lands continue to have an opportunity to confirm their eligibility for the additional discounts under the Enhanced Lifeline/Link-Up programs, the enrollment forms should include a procedure for customers to certify their Enhanced Lifeline/Link-Up eligibility. Accordingly, CertA should collect and maintain information regarding customers' eligibility for these additional discounts. Joint Consumers also urged the Commission to reconsider the Small LECs' recommendation because they are concerned that customers applying for Enhanced Lifeline/Link-Up discounts may be confused by the separate application process. Thus, the application process may pose a barrier to enrollment in this important program which is designed to improved telephone access to Tribal Lands, some of the poorest regions of the country.¹³

Including a procedure for customers to certify eligibility for the federal programs and requiring CertA to collect and maintain this information would violate Public Utilities Code Section 277(c), which prohibits ULTS funds from being expended for non-ULTS related purposes. Furthermore, the Commission has addressed this issue in D.05-04-026.¹⁴ Therefore, the Small LECs' recommendation is without merit and is rejected.

· Utilities' verification responsibilities should end on May 1, 2006.¹⁵

Small LECs asserted that to streamline the transition to the new certification and verification processes, instead of July 1, 2006, the CertA should assume responsibility for verifying existing ULTS customers whose renewal dates are on May 1, 2006 or after. This would minimize customers' confusion when they receive the uniform customer notification informing them that the verification process will be assumed by the CertA and their annual re-certification forms from utilities asking customers to complete and return these back to the utilities.

TD considered this issue when identifying the implementation date of the new ULTS program. TD believes that a coincident implementation date for the certification and verification processes would create less confusion for utilities which have to implement GO 153, new customers who are interested in enrolling in the ULTS program, and existing customers who will be re-certifying their continued eligibility. AT&T also urges the Commission to deny the Small LEC's recommendation indicating that the Small LEC's proposal is without legal or reasonable factual grounds and would essentially revoke the current ULTS program benefits to existing customers prior to the new program implementation date.¹⁶ Therefore, the Small LECs' recommendation is rejected.

· This Resolution should specifically require TD and CertA to begin working on the development of electronic formats for the enrollment forms.¹⁷

As acknowledged by Joint Consumers in their comments,¹⁸ this issue has been addressed by the Commission in D.05-12-013, and therefore is rejected.

· A brief sentence should be added to the uniform customer notification alerting new ULTS customers that the certification process will be conducted by CertA. ¹⁹

The uniform customer notification directs customers interested in enrolling in ULTS to contact their local telephone companies. Pursuant to Sections 4.1 and 4.2 of the Revised GO 153, utilities are required to inform customers of the availability of the ULTS program, eligibility requirements and the certification process. Therefore, it is not necessary to have this information included in the uniform customer notification. Accordingly, this recommendation is rejected.

Findings

1. This resolution implements Decision (D.) 05-12-013.

2. Attachment A to this Resolution includes the certification and verification forms for enrollment in the Universal Lifeline Telephone Service (ULTS) program, and should be adopted.

3. Revised General Order (GO) 153 adopted in D.05-12-013 and the enrollment forms adopted in this Resolution should take effect on July 1, 2006.

4. Utilities should cease the annual re-certification for their ULTS customers whose ULTS qualification renewal dates are July 1, 2006 or after.

5. Attachment B includes a uniform customer notification informing customers on the ULTS program changeover from self-certification to means-tested/income-documented requirement, and should be adopted. Within 15 business days from the effective date of this Resolution, TD should make available, to utilities upon request, the same uniform customer notification in the following languages: Spanish, Chinese, Korean, Japanese, Vietnamese, and Tagalog.

6. Utilities should send the uniform customer notification adopted in this Resolution as a bill insert to their residential and ULTS customers except for customers of foreign exchange or farmer lines. This customer notification should be included in monthly bills rendered from June 1, 2006 through June 30, 2006.

7. GO 153 § 4.3 requires every utility to annually send to all of its residential customers, other than customers of ULTS, foreign exchange or farmer lines, a notice that contains information about the ULTS program.

8. To minimize consumer's confusion on the changeover of the ULTS program from the existing self-certification to the new means-tested/income-documented requirement, utilities should suspend their annual ULTS notices informing customers of the availability of existing ULTS program that are scheduled to be mailed on May 1, 2006 or after.

9. Commencing May 1, 2007, utilities should resume the GO 153 § 4.3 requirement in accordance with their own established mailing schedule with a new notice containing information about the new ULTS program.

10. In compliance with PU Code § 311(g), a Notice of Availability was e-mailed on January 31, 2006, to every certificated telecommunications carriers, parties of record in R.04-12-001, and ULTS Administrative Committee members informing them that a draft of this Resolution is accessible on the Commission's web-site (www.cpuc.ca.gov) and is available for public comments.

11. On February 15, 2006, Small LECs, Joint Consumers, Cox Communications (Cox), Verizon California Inc. (Verizon), and AT&T California (AT&T) filed comments, and on February 22, 2006, AT&T, Cox and Joint Consumers filed reply comments.

12. Parties' recommendations that are technical in nature and involve minor revisions should be incorporated into the enrollment forms and the uniform customer notification.

13. AT&T should be permitted to send the uniform customer notification translated into Vietnamese, Chinese, Japanese, Korean and Tagalog as a direct mailer on June 2006.

14. It should be confirmed that utilities have the ability to alter the format and font size of the uniform customer notification.

15. TD should update the ULTS income limits applicable for the period June 1, 2006 through May 31, 2006 within 15 days from the effective date of this Resolution.

THEREFORE, IT IS ORDERED that:

1. The enrollment forms for the Universal Lifeline Telephone Service (ULTS) program attached as Attachment A are adopted

2. Revised General Order (GO) 153 adopted in Decision (D.) 05-12-013 and the enrollment forms adopted in this Resolution shall take effect on July 1, 2006.

3. Utilities shall cease the annual re-certification for their ULTS customers whose ULTS qualification renewal dates are July 1, 2006 or after.

4. The uniform customer notification attached as Attachment B is adopted. This customer notification is to be sent as a bill insert by all utilities to their residential and ULTS customers other than customers of foreign exchange or farmer lines. This customer notification shall be included in monthly bills rendered from June 1, 2006 through June 30, 2006. Within 15 business days from the effective date of this Resolution, the Commission's Telecommunications Division shall make available, to utilities upon request, the same uniform customer notification in the following languages: Spanish, Chinese, Korean, Japanese, Vietnamese, and Tagalog for use in utilities' mailing.

5. Utilities shall suspend their annual ULTS notice in accordance with § 4.3 of the GO that is scheduled to be mailed between May 1, 2006 and April 30, 2007.

6. Commencing May 1, 2007, utilities shall resume the GO 153 § 4.3 requirement in accordance with their own established mailing schedule with a new notice containing information about the new ULTS program.

This Resolution is effective today.

I hereby certify that this Resolution was adopted by the Public Utilities Commission at its regular meeting on March 2, 2006. The following Commissioners approved it:

/s/ STEVE LARSON

STEVE LARSON Executive Director

MICHAEL R. PEEVEY President

GEOFFREY F. BROWN

DIAN M. GRUENEICH

JOHN A. BOHN

RACHELLE B. CHONG

Commissioners

ATTACHMENT A

ULTS ENROLLMENT FORMS

UNIVERSAL LIFELINE TELEPHONE SERVICE (ULTS)

INSTRUCTIONS FOR COMPLETING THE ULTS CERTIFICATION FORM

PLEASE READ ALL INSTRUCTIONS CAREFULLY

Upon your request, your telephone company has enrolled you in the Universal Lifeline Telephone Service (ULTS) program. This is a discount program for low-income customers provided by the local telephone companies and sponsored by the California Public Utilities Commission (CPUC). You must certify your eligibility by completing the enclosed form. The completed form and support documents, if any, must be received by the Certifying Agent, an agent of the CPUC, by:

<insert date>.

A self-addressed return envelope is provided for your use. If a completed form is not received by the above date, the CPUC will direct your telephone company to:

o remove you from the ULTS program

o change your service to full-priced residential telephone service back to the ULTS Start Date listed in Part A Carrier Information of the attached form;

o back bill you for the ULTS discounts that you should not have received including the non-recurring charges, the monthly recurring rate, the end-user common line charge, related surcharges, taxes and fees; and

o require a service deposit from you, if applicable.

ULTS Eligibility

The Commission or the Commission's agent may audit your eligibility to participate in the ULTS program at any time. If the audit finds that you are not eligible, you will be removed from the ULTS program and billed for previous ULTS discounts that you should not have received plus interest at the 3-month commercial paper rate.

IF YOU HAVE QUESTIONS ABOUT THESE FORMS: Call toll-free from 7:00 AM to 7:00 PM on regular business days. Toll-free 1-###-###-#### or TTY 1-###-###-####

INSTRUCTIONS FOR COMPLETING CERTIFICATION FORM

Part A Carrier Information This part identifies your telephone company, your ULTS phone number(s), and the date your ULTS service begins. If any information in Part A is incorrect, please call the telephone company at the phone number listed on the form next to the telephone company's name.

Part B Billing Address and Service Address Service Address as shown on the form should be your principal place of residence. If any information in Part B is incorrect, please call the telephone company at the phone number listed on the form next to the telephone company's name in Part A.

ULTS Certification Form Instructions Page 2

Part C Eligibility You may use either Method 1 OR Method 2 to qualify for ULTS. Do NOT choose both.

If you are using Method 1 Program-Based, fill in the bubble relating to the program you or another person in your household is enrolled in and provide the name of that person in the box marked "Name:".

If you are using Method 2 Income-Based, fill in the bubble relating to the combined number of adults and children in your household. You must provide proof that your total household income is at or below the ULTS maximums when returning the certification form. Acceptable income documents are:

· Your prior year's state, federal or tribal tax return; or

· Any of the following documents that represent your total household income: o Income statements or paycheck stubs for three consecutive months within the calendar year o Child support document o Statement of benefits from Social Security, Veterans Administration, retirement/pension, unemployment compensation, and/or workmen's compensation o A divorce decree o Other official documents

Do not staple or tape the income documents to the form, and be sure to send only copies because these documents will not be returned to you.

Household income is defined as all revenues received by everyone in your household, whether taxable or non-taxable, including, but not limited to: wages, salaries, interest, dividends, spousal support and child support, grants, gifts, allowances, stipends, public assistance payments, social security and pensions, rental income, income from self-employment and cash payments from other sources, and all employment-related, non-cash income.

Below description and the related part in the certification form, will be displayed only if the customer is subscribed to a 2^nd ULTS Line.

Your telephone company has enrolled you for a 2^nd ULTS Line because you have a disabled person in your household. To qualify for the 2^nd ULTS Line, you must complete this part of the form. To qualify for the 2^nd ULTS Line, the disabled person must have immediate and continuous access to a telephone-text device (TTY). If the TTY is not issued by the Deaf and Disabled Telecommunications program, remember to attach a medical certificate indicating the person's need for a TTY when submitting the form.

Part D Signature By signing the form, you are certifying, under penalty of perjury, that the service address is your principal place of residence, you have not been claimed as a dependent on another person's income tax return, and the information in the certification form is true and correct. You must print your name under your signature. Use only black or blue ink. If the form is signed by a Legal Guardian or a person with Power of Attorney, please fill in the bubble.

Part E How do you prefer to receive future notifications? You will be notified in writing once it is determined whether you qualify for the ULTS program. Also, to continue on the ULTS program, you must verify your eligibility each year. If you prefer to receive future notifications including your next verification form in Braille (English only) or in large-font, please specify your preference by filling in the correct bubble.

PLEASE REMEMBER:

1. Keep these instructions for your files, do not send with application.

2. We must receive your completed form by <insert date>.

3. Do not send your original income document(s), send COPIES only because they will NOT be returned to you.

Please return form to:

Certifying Agent for ULTS

PO Box 0000

Oxnard, CA 93036-0000

1-###-###-#### TTY 1-###-###-####

Universal Lifeline Telephone Service

(ULTS) www.cpuc.ca.gov

CERTIFICATION FORM

Part B Billing Address Part A Carrier Information

Jane Doe SBC Communications 1-###-###-####

123 Maple St., Apt. #1 ULTS Phone Number: 213-612-4690

Los Angeles, CA 90048-1000 <2^nd ULTS: 213-612-4691>

ULTS Start Date: 02/26/06

Part B Service Address

123 Maple St., Apt #2

Los Angeles, CA 90048-1000

This completed form must be received by <insert date> to qualify for the ULTS discount program.

This form is valid only for the person listed in Part B Billing Address above.

DO NOT COPY THIS FORM.

ULTS Certification Form BarCode

Part C Eligibility -You may use either Method 1 OR Method 2 below to qualify for ULTS.

Method 1 Program-Based: If you or another person in your household is enrolled in any of the programs below, please identify the program by filling in the correct bubble and provide the name of that person in the Name box. Sample:

o Medicaid/Medi-Cal

o Low Income Home Energy Assistance Program (LIHEAP)

o Supplemental Security Income (SSI)

o Federal Public Housing Assistance (Section 8)

o Food Stamps

o Temporary Assistance for Needy Families (TANF)

o Healthy Families Category A

o National School Lunch's FREE Lunch Program (NSL)

o Tribal TANF

o Bureau of Indian Affairs General Assistance

o Tribal NSL

o Tribal Head Start

o Women, Infant and Children Program (WIC)

Name:

Copyright 2006 Form 3a 01-06

(If you complete Method 1 above, do not complete Method 2 below)

Method 2 Income-Based: If the income level for your household is at or less than the ULTS maximums listed below, please identify your household size by filling in the correct bubble. YOU MUST PROVIDE PROOF OF YOUR TOTAL HOUSEHOLD INCOME.

2nd ULTS l Line- You have a disabled person in your household and this person has immediate and continuous access to a TTY. Please provide the name of the disabled person using the TTY in the name box and fill in the correct bubble below.

Name:

who uses a TTY issued by Deaf and Disabled Telecommunications Program.

who uses a TTY but not issued by DDTP. (You must attach a medical certificate indicating the person's need for a TTY.)

Part D Signature By signing below, I certify, under penalty of perjury, that the service address is my principal place of residence, I have not been claimed as a dependent on another person's income tax return, and the information in this form is true and correct. Please note the printed name must match the person's name in Part B of this form unless this form is signed by a Legal Guardian or a person with Power of Attorney.

Part F Please fill in if you prefer to receive future notifications in: Large Print Braille

UNIVERSAL LIFELINE TELEPHONE SERVICE (ULTS)

INSTRUCTIONS FOR COMPLETING ULTS VERIFICATION FORM

PLEASE READ ALL INSTRUCTIONS CAREFULLY

You are enrolled in the Universal Lifeline Telephone Service (ULTS) program. This is a discount program for low income-customers provided by the local telephone companies and sponsored by the California Public Utilities Commission (CPUC). To remain in the program, you must verify your eligibility by completing the enclosed verification form. The completed form must be received by the Certifying Agent, an agent of the CPUC by:

<insert date>.

A self-addressed return envelope is provided for your use. If a completed form is not received by the above date, the CPUC will direct your telephone company to:

o remove you from the ULTS program

o change your service to full-priced residential telephone service from the ULTS Verification Date listed in Part A of the form;

o require a service deposit from you, if applicable.

ULTS Eligibility

The Commission or the Commission's agent may audit your eligibility to participate in the ULTS program at any time. If the audit finds that you are not eligible, you will be removed from the ULTS program and billed for previous ULTS discounts that you should not have received plus interest at the 3-month commercial paper rate.

IF YOU HAVE QUESTIONS ABOUT THESE FORMS: Call toll-free from 7:00 AM to 7:00 PM on regular business days. Toll-free 1-###-###-#### or TTY 1-###-###-####

INSTRUCTIONS FOR COMPLETING THE FORM

Part A Carrier Information This part identifies your telephone company, your ULTS phone number(s), and your ULTS Verification date, i.e. your annual re-certification date. If this information is incorrect because you recently changed telephone company or ULTS phone number(s), please continue to fill out and return this form because these changes will not affect your ULTS qualification.  We will receive your changed information from your telephone company.  If this information is incorrect and you have made no changes recently, please report the problem to your telephone company.

Part B Billing Address and Service Address Service address listed on the form should be your principal place of residence. If any information in Part B is incorrect, please call your telephone company at the phone number listed on the form next to the telephone company's name in Part A.

Part C Eligibility You may use either Method 1 OR Method 2 to qualify for ULTS. Do NOT choose both.

If you are using Method 1 Program-Based, fill in the bubble relating to the program you or another person in your household is enrolled in and provide the name of that person in the box marked "Name:".

If you are using Method 2 Income-Based, fill in the bubble relating to the combined number of adults and children in your household.

Household income is defined as all revenues received by everyone in your household, whether taxable or non-taxable, including, but not limited to: wages, salaries, interest, dividends, spousal support and child support, grants, gifts, allowances, stipends, public assistance payments, social security and pensions, rental income, income from self-employment and cash payments from other sources, and all employment-related, non-cash income.

ULTS Verification Form Instructions Page 2

Part C Eligibility: Continued

Below description and the related part in the verification form, will be displayed only if the customer is subscribed to a 2^nd ULTS Line

You have been qualified for and subscribe to a 2^nd ULTS Line. To continue the qualification of the 2^nd ULTS Line, you must complete this part of the form.

Part D Signature By signing the form, you are certifying, under penalty of perjury, that the service address is your principal place of residence, you have not been claimed as a dependent on another person's income tax return, and the information in this form is true and correct. You must print your name under your signature. Use only black or blue ink. If the form is signed by a Legal Guardian or a person with Power of Attorney, please fill in the bubble.

Part E How would you prefer to receive future notifications? To continue on the ULTS program, you must verify your eligibility every year. If you prefer to receive future notifications including your next verification form in Braille (English Only) or in large-font, please specify your preference by filling in the applicable bubble.

Please return form to:

Certifying Agent for ULTS

PO Box 0000

Oxnard, CA 93036-0000

1-###-###-#### TTY 1-###-###-####

Universal Lifeline Telephone Service

(ULTS) www.cpuc.ca.gov

VERIFICATION FORM

Part B Billing Address Part A Carrier Information

Jane Doe SBC Communications 1-###-###-####

123 Maple St., Apt. #1 ULTS Phone Number: 213-612-4690

Los Angeles, CA 90048-1000 <2^nd ULTS: 213-612-4691>

Verification Date: 02/26/06

Part B Service Address

123 Maple St., Apt #2

Los Angeles, CA 90048-1000

This completed form must be received by <insert date> to qualify for the ULTS discount program.

This form is valid only for the person listed in Part B Billing Address above.

DO NOT COPY THIS FORM.

ULTS Verification Form BarCode

Part C Eligibility -You may use either Method 1 OR Method 2 below to qualify for ULTS.

Method 1 Program-Based: If you or another person in your household is enrolled in any of the following programs, please identify the program by filling in the correct bubble below and provide the name of that person in the Name box. Sample:

o Medicaid/Medi-Cal

o Low Income Home Energy Assistance Program (LIHEAP)

o Supplemental Security Income (SSI)

o Federal Public Housing Assistance (Section 8)

o Food Stamps

o Temporary Assistance for Needy Families (TANF)

o Healthy Families Category A

o National School Lunch's FREE Lunch Program (NSL)

o Tribal TANF

o Bureau of Indian Affairs General Assistance

o Tribal NSL

o Tribal Head Start

o Women, Infant and Children Program (WIC)

Name:

Copyright 2006 Form 3a 01-06

(If you complete Method 1 above, do not complete Method 2 below)

Method 2 Income-Based: If the income level for your household is at or less than the maximum ULTS income listed below, please identify your household size by filling in the correct bubble below.

2nd ULTS line- You have been qualified for and subscribe to a 2^nd ULTS Line. To continue your qualification, please fill in the correct bubble and appropriate information below:

< insert name > is a household member and has immediate and continuous access within the household to a TTY.

A new household member is using the TTY issued by DDTP.

A new household member is using the TTY. (You must attach a medical certificate indicating the person's need for a TTY.)

Name of the new household member:

Part D Signature By signing below, I certify, under penalty of perjury, that the service address is my principal place of residence, I have not been claimed as a dependent on another person's income tax return, and the information in this form is true and correct. Please note the printed name must match the person's name listed in Part B of this form unless this form is signed by a Legal Guardian or a person with Power of Attorney.

Part E Please fill in if you prefer to receive future notifications in: Large Print Braille

ATTACHMENT B

UNIFORM CUSTOMER NOTIFICATION

THIS IS AN IMPORTANT NOTICE

FROM

THE CALIFORNIA PUBLIC UTILITIES COMMISSION

www.cpuc.ca.gov

Starting July 1, 2006, new rules for enrolling and re-certifying Universal Lifeline Telephone Service (ULTS) customers will take effect.

ULTS is a discount program for low-income customers provided by the local telephone companies and sponsored by the California Public Utilities Commission (CPUC). If you qualify for ULTS, you are entitled to the following:

Service	Description	Rate
Flat-Rate Local Telephone Service	Unlimited local calls.	Monthly: the lower of $5.34* or 1/2 of utility's rate for residential flat-rate local telephone service.
Service Connection	For initiation of telephone service.	Non-recurring:  the lower of $10.00 or 1/2 of utility's connection charge for residential telephone service.
Service Conversion	For change of class/type/grade of service.	Non-recurring:  the lower of $10.00, 1/2 of utility's connection charge for residential telephone service, or the utility's regular tariffed conversion charge.

* Rates are lower for measured-service, two-party access lines, and service in federally recognized Tribal lands, and are higher for extended-area service when these services are offered by the local telephone companies.

You may also qualify for a 2^nd ULTS Line if you or another person in your household is disabled and needs a telephone-text device (TTY) when using the phone.

Starting July 1, 2006, you may qualify for ULTS under either Method 1 Program-Based OR Method 2 Income-Based.

Method 1 Program-Based: you qualify for ULTS if you or another person in your household is enrolled in any one of the following public-assistance programs:

Medicaid/Medi-Cal	Low Income Home Energy Assistance Program (LIHEAP)
Supplemental Security Income (SSI)	Federal Public Housing Assistance (Section 8)
Food Stamps	Temporary Assistance for Needy Families (TANF)
Healthy Families Category A	National School Lunch's FREE Lunch Program (NSL)
Tribal TANF	Bureau of Indian Affairs General Assistance
Tribal NSL	Tribal Head Start
Women, Infant and Children Program (WIC)

Method 2 Income-Based: you qualify for ULTS if your total household income is at or less than the ULTS income maximums:

Household Size	Maximum ULTS Yearly Income (6/1/06 through 5/31/07)
1-2 Members	$
3 Members	$
4 Members	$
5 Members	$
	For each additional member after 5 members, add $ to $

Household income is defined as all revenues received by everyone in your household, whether taxable or non-taxable, including, but not limited to: wages, salaries, interest, dividends, spousal support and child support, grants, gifts, allowances, stipends, public-assistance payments, social security and pensions, rental income, income from self-employment and cash payments from other sources, and all employment-related, non-cash income.

NEW ULTS CUSTOMERS: If you think you qualify for ULTS, please contact your local telephone company: <insert carrier name> at <insert phone number>. To qualify under Method 2 Income-Based, you must also provide documents proving that your total household income is at or below the ULTS income maximum. Acceptable income documents are:

· Prior year's state, federal, or tribal tax return; or

· Any of the following income documents that represent your total household income:

o Income statements or paycheck stubs for three consecutive months within the calendar year

o Statement of benefits from Social Security, Veterans Administration, retirement/pension, unemployment compensation, and/or workmen's compensation

o A divorce decree

o Child support document

o Other official documents

EXISTING ULTS CUSTOMERS: If you are an existing ULTS customer and your next annual re-certification is due on or after July 1, 2006, instead of your local telephone company, your next annual re-certification will be conducted by the Certifying Agent, an agent of the CPUC. A verification form for re-certification will be mailed to you directly from the Certifying Agent. If you have questions about your next re-certification, call toll-free at 1-###-###-#### or TTY 1-###-###-#### from 7:00 AM to 7:00 PM on regular business days. You will have the option of continuing your ULTS enrollment under Method 1 Program-Based or Method 2 Income-Based.

Eligibility Audit: The Commission or the Commission's agent may audit your eligibility to participate in the ULTS program at any time. If the audit finds that you are not eligible, you will be removed from the ULTS program and billed for previous ULTS discounts that you should not have received plus interest at the 3-month commercial paper rate.

¹ Consistent with GO 153, utilities are defined as telecommunications carriers that offer ULTS and all telecommunications carriers that offer residential local exchange service are required to offer ULTS.

² CertA is an agent of the Commission under contract to qualify ULTS customers.

³ D.05-12-013 states: TD and our Public Advisor's Office are to develop a uniform customer notification for carriers that provide residential and ULTS services to send as a bill insert to those customers. (At page 54)

⁴ ULTS customers are exempted from GO 153 § 4.3 because they do not need to be informed about the availability, terms and conditions of ULTS.

⁵ The Small LECs include: Calaveras Telephone Co., Cal-Ore Telephone Co., Ducor Telephone Co., Foresthill Telephone Co., Global Valley Networks, Happy Valley Telephone Co., Hornitos Telephone Co., Kerman Telephone Co., Pinnalces Telephone Co., The Pondeosa Telephone Co., Sierra Telephone Co. Inc., The Siskiyou Telephone Co., Volcano Telephone Co., and Winterhaven Telephone Co.

⁶ The Joint Consumers include: The National Consumer Law Center, The Utility Reform Network, Disability Rights Advocates, The Greenlining Institute, The Latino Issues Forum, and The Asian Law Caucus.

⁷ Cox is the dba forCox California Telcom, LLC.

⁸ AT&T is the dba for Pacific Bell Telephone Co.

⁹ AT&T's comments at 4.

¹⁰ Ibid.

¹¹ Verizon's comments at1.

¹² Small LECs' comments at 4 and Joint Consumers' reply comments at 1.

¹³ Joint Consumers' reply comments at 1.

¹⁴ Joint Consumers' reply comments at 1 and AT&T's reply comments at 2.

¹⁵ Small LECs' comments at 3.

¹⁶ AT&T's reply comments at 1.

¹⁷ Joint Consumers' comments at 2.

¹⁸ Joint Consumers' comments at 3.

¹⁹ Joint Consumers' reply comments at 1.