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OUS Fund Forms and Instructions
OUS1 Worksheet: Telecommunications Service Provider Identification
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OUS1 Worksheet

OUS1 Worksheet Instruction
At the top right-hand corner of the worksheet is a space for the company identification number. This number is assigned by PUC and used by the fund administrator to identify the telecommunications service provider (TSP) and track all transactions with the provider. That ID number should be shown on all worksheets and future communications between the provider and the administrator.
 
Block 1: Telecommunications Service Provider Identification
 
Line 1: Requests the legal name of the provider as it appears on articles of incorporation or other legal documents. Each entity must file a separate worksheet.
 
Line 2: Requests the principal name under which the provider conducts telecommunications activities. This would typically be the name that appears on customer bills or the name used when service representatives answer customer inquiries. 
 
Line 3: Requests the classification of the TSP as an incumbent telecommunications utility (including a cooperative), or a competitive telecommunications service provider as defined in OAR 860-031-0001, or as a radio common carrier (RCC).
 
Line 4a: Provides a check-off of the principal telecommunications business of the provider. This check-off should be consistent with the provider’s application for certification.
1.  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).
2.  Local Exchange Switched Service means the provision of switched telecommunications services within the boundaries of the exchange, as filed with and approved by PUC. For OUS purposes, this classification includes the provision of switched access and local interconnection services to other providers. See OAR 860-032-0001(4).
3.  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.
4.  Toll Switched Service means the provision of interexchange long distance message toll services. See OAR 860-032-0001(13).
5.  Toll Non-Switched Service means the provision of interexchange long distance private line services.
6.  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).
7.  Cellular/PCS/CMR means radio (wireless) telecommunications used for cellular, personal communications service (PCS), and commercial mobile radio service (CMR).
8.  Paging/Messaging means radio telecommunications used for paging and messaging.

Line 4b: Provides a check-off of 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: Requests the name of the provider’s holding company or controlling entity, if any.
 
Line 6: Requests 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 fund administrator.
 
Line 7: Requests principal carrier identification code used for interexchange service.
 
Line 8: Requests the mailing address of the corporate headquarters of the provider.
 
Line 9: Requests a telephone number that can be used for customer inquiries.
 
Block 2: Contact Information
 
Line 10: Requests the name of a contact person who can provide clarification, additional information, and if necessary serve as the first point of contact for the OUS administrator.
 
Line 11a and b: Requests the telephone number and FAX number of the contact person.
 
Line 12: Requests the e-mail address of the contact person.
 
Line 13: Requests the complete mailing address of the contact person. Worksheets from the fund administrator will be mailed to this address; therefore it is critical that this information be 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: Requests 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: Requests the signature of an officer of the company. In lieu of an officer signature, a company-designated manager may sign. That officer or manager certifies the accuracy of the information provided to the fund administrator.
 
Line 16: Requests the printed name of the officer or manager.
 
Line 17: Requests the position of the officer or manager.
 
Line 18: Requests the date the OUS1 form was signed