Disbursements

Sample Remittance Statements

Election of either electronic or paper remittance statements is indicated on the FCC Form 498 (Service Provider Identification Number and General Contact Information Form). Service providers may change their election by filing a revision to FCC Form 498. Existing users may file revisions online. The form may also be submitted to USAC in a hardcopy format. 

For service providers that receive electronic remittance statements, the sample documents provided below offer a detailed example of the kind of information provided in a remittance statement.

High Cost: Electronic Remittance Statement sample

Lifeline: Electronic Remittance Statement sample

Rural Health Care: Electronic Remittance Statement sample

Schools and Libraries: Electronic Remittance Statement sample