Step 4 Submit Funding Requests

Once the most cost-effective service provider(s) and services have been selected the health care provider (HCP) should complete and submit a FCC Form 466 (Funding Request and Certification Form) and/or an FCC Form 466-A (Internet Service Funding Request and Certification Form). The FCC Forms 466 and 466-A specify the type of service(s) ordered, cost, name of service provider(s), terms of the service agreement(s), and certify that the selections were the most cost-effective offers received. One form should be used for each service (or circuit).

Use the FCC Form 466 for telecommunications services and the FCC Form 466-A for Internet services. On the FCC Form 466, an HCP may request telecommunications support based strictly on its circuit distance (mileage-based charges) or may request support based on the difference between what it pays and what an equivalent circuit would cost in any city with a population of 50,000 or more in the health care provider's state. HCPs requesting support for Internet access charges on the FCC Form 466-A will receive support for 25 percent of the monthly Internet charges.

Submit these forms with supporting documentation, which includes:

• A copy of a bill for the selected services within the current funding year that shows the rural rate entered on the form
• A copy of the contract (if applicable) signed by both the service provider and the HCP after the allowable contract selection date (ACSD)
• Urban rate information (if not using the RHC-provided urban rates)
• A copy of all bids (if applicable)

To obtain the information and documents necessary to complete the FCC Form 466 and the FCC Form 466-A, the HCP may need to work with the selected service provider. The service provider may need to provide detailed circuit information, a circuit diagram, a documented urban rate, or contract information.

All certification boxes must be checked on the FCC Form 466 and FCC Form 466-A. Paper FCC Form 466 and FCC Form 466-A submissions must have a dated original (not photocopied) signature of a person authorized to enter into an agreement for the HCP. Once the FCC Form 466 and/or FCC Form 466-A and all related documentation have been completed, the health care provider should submit all documents to USAC for review. E-certification may be used for the FCC Form 466 and FCC Form 466-A submitted through the USAC website, but note that the supporting documentation must be emailed or mailed to USAC.

Forms with missing or incomplete information or documentation cannot be processed. USAC reviews the form(s) and supporting documentation, collectively known as a "packet," for accuracy and completeness, and will contact the HCP if there are any questions or missing information. Health care provider and service provider representatives are strongly encouraged to respond to USAC inquiries in a timely manner as incomplete packets cannot be processed, and non-responsiveness may result in a denial of funding.