Once the most cost-effective service provider(s) and services have been selected, the health care provider (HCP) should complete and submit the FCC Form 466 (Funding Request and Certification Form). The FCC Form 466 specifies the type of service(s) ordered, cost, name of service provider(s), and terms of the service agreement(s), and certifies that the selections were the most cost-effective offers received. One form should be used for each service (or circuit).
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.
Submit this form with supporting documentation.
To obtain the information and documentation necessary to complete the FCC Form 466, 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. Paper FCC Form 466 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 all related documentation have been completed, the HCP should submit all documents to USAC for review. E-certification may be used for the FCC Form 466 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 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 forms cannot be processed, and non-responsiveness may result in a denial of funding. Submit the FCC Form 466 and all supporting documentation prior to the last day of the funding year. If the last day of the funding year is a weekend or holiday, then the deadline is the next business day.
To submit the forms and supporting documentation: