HCF Program Training Overview of FCC Forms: Consortia Rural Health Care Program I 2013 HCF Program Training 1 This training is just a general overview and starting point for applicants Every applicant s situation is different The training does not cover every program requirement The training does not cover requirements for service providers and consultants It is essential to read the following documents carefully as you proceed through the planning and application process: Healthcare Connect Fund Order (FCC 12 150), located at http://www.fcc.gov/encyclopedia/rural health care, The Rural Health Care Program rules, 47 C.F.R. 54.600 680, located at http://www.ecfr.gov, and The Healthcare Connect Fund Program forms and instructions (FCC Forms 460 463), located at http://www.usac.org/rhc/healthcareconnect/tools/forms/default.aspx. Consult the FCC and USAC websites for additional resources. Important Caveat Rural Health Care Program I 2013 HCF Program Training 2 1
Agenda 1. FCC Form 460: Eligibility and Registration Form 2. FCC Form 461: Request for Services Form 3. FCC Form 462: Funding Request Form 4. FCC Form 463: Invoice and Request for Disbursement Form Rural Health Care Program I 2013 HCF Program Training 3 Forms Overview FCC Form 460 Rural Health Care Program I 2013 HCF Program Training 4 2
FCC Form 460 Differences Between Online Application and Paper Form All forms and documentation must be submitted online through My Portal. Not every line/block of the paper form will appear in My Portal. The form process in My Portal does not follow the exact order of the paper form. Rural Health Care Program I 2013 HCF Program Training 5 FCC Form 460 Purpose of the FCC Form 460: To determine eligibility of the consortium and all health care provider (HCP) sites to participate in the Healthcare Connect Fund (HCF) Program To register: Off site data centers Off site administrative offices Ineligible HCP sites All HCPs, consortia, and consortium members must obtain an eligibility determination, even if deemed eligible for another program. Rural Health Care Program I 2013 HCF Program Training 6 3
FCC Form 460 Before You File A consortium using a consultant to file FCC Form 460 must first submit a third party authorization agreement with USAC. Agreement assigns legal responsibility for representations a consultant may make in application to the consortium Assemble required FCC Form 460 information: Agreement assigning legal and financial responsibility to any entity other than consortium leader if applicable Consortium FCC Registration Number (if a legal entity) Account holder contact information Rural Health Care Program I 2013 HCF Program Training 7 FCC Form 460 Getting Access Enter through E File and select New RHC applicant. Follow the directions at the Create FCC Form 460 page. Select New HCP. Select the radio dial button that best describes why you are submitting the FCC Form 460 (Line 2), Determine eligibility of consortium. Rural Health Care Program I 2013 HCF Program Training 8 4
FCC Form 460 FCC Form 460 Options Rural Health Care Program I 2013 HCF Program Training 9 FCC Form 460 Information Required to Submit through My Portal Consortium information Consortium leader information Contact information HCP eligibility category Certifications Signature Rural Health Care Program I 2013 HCF Program Training 10 5
FCC Form 460 Consortium Information FCC Form 460 application number and HCP number will be automatically generated. Enter the name of the consortium. If the consortium is a legal entity, select Yes. If the consortium is a legal entity, enter the entity s FCC Registration Number and nonprofit tax ID. Rural Health Care Program I 2013 HCF Program Training 11 FCC Form 460 Consortium Information Rural Health Care Program I 2013 HCF Program Training 12 6
FCC Form 460 Consortium Leader Information If the consortium leader has assigned legal and financial responsibility to another entity, check yes and upload a copy. Select Consortium Leader Type from drop down menu Include the HCP number for an eligible HCP participating in the consortium. Government organizations, public sector entities, and non profit entities, must upload a request for an exemption from USAC in order to be a consortium leader if they also plan to participate as a service provider during the competitive bidding process. Enter consortium leader contact information, including name and address Rural Health Care Program I 2013 HCF Program Training 13 FCC Form 460 Consortium Leader Information Enter all the pertinent information for the consortium leader. Rural Health Care Program I 2013 HCF Program Training 14 7
FCC Form 460 Contact Information Rural Health Care Program I 2013 HCF Program Training 15 FCC Form 460 Contact Information Enter contact information for the consortium project coordinator. The project coordinator will serve as the primary account holder for the consortium. Secondary account holders can also be added at this time Check the radio button and click the New Secondary Account Holder box. Rural Health Care Program I 2013 HCF Program Training 16 8
FCC Form 460 HCP Eligibility Category Rural Health Care Program I 2013 HCF Program Training 17 FCC Form 460 HCP Eligibility Category Consortium of the above is automatically selected for Line 43 for consortium applicants. Provide a brief explanation that describes why the entity qualifies as a consortium. Rural Health Care Program I 2013 HCF Program Training 18 9
FCC Form 460 Signature Provide name and contact information of the person authorized to submit the FCC Form 460, including FCC RN number of their employer. Reminder: The project coordinator is required to be an officer, director, or authorized employee of the consortium leader. Rural Health Care Program I 2013 HCF Program Training 19 FCC Form 460 Certifications The project coordinator or an authorized designee must provide the certifications and electronic signature. Rural Health Care Program I 2013 HCF Program Training 20 10
FCC Form 460 Signatures New applicants: password not required to submit the form Applicants with existing My Portal credentials: your current password will be populated in the Signature section Rural Health Care Program I 2013 HCF Program Training 21 FCC Form 460 Previewing the Form Carefully review information you provided on the form. If you need to make changes, click Save and Go Back or select the applicable section of the form at the top. If no changes are needed, click Certify to sign and submit the form. Rural Health Care Program I 2013 HCF Program Training 22 11
FCC Form 460 Sign and Submit Electronic signature = a hand written signature Click Certify to complete the process. A confirmation page will alert you that the form was successfully submitted. The project coordinator will receive a confirmation that the FCC Form 460 was submitted. (Note: the confirmation is not an approval of the form.) Rural Health Care Program I 2013 HCF Program Training 23 FCC Form 460 Participating Entities After USAC determines that the consortium and consortium leader are eligible, the consortium leader can add HCP sites to the Form 460 on Line 24. A consortium can submit an FCC Form 460 for sites on its network if is has received a Letter of Agency (LOA) covering each of those sites. A consortium must submit an FCC Form 460 for all ineligible entities, off site data centers, and off site admin offices on its network. Rural Health Care Program I 2013 HCF Program Training 24 12
Forms Overview FCC Form 461 Rural Health Care Program I 2013 HCF Program Training 25 FCC Form 461 Purpose of the FCC Form 461 Used to initiate the competitive bidding process Provides necessary information to potential service providers about the requested services, network equipment, and/or facilities to enable effective competitive bidding Rural Health Care Program I 2013 HCF Program Training 26 13
FCC Form 461 6 Blocks of Requested Information Block 1: General Information Block 3: Consortium Request for Services Block 4: Declaration of Assistance Block 5: Bid Evaluation Block 6: Additional Documentation Block 7: Certifications (and Signature) Rural Health Care Program I 2013 HCF Program Training 27 FCC Form 461: Block 1 Block 1: General Information Complete Block 1 with site specific information. Note: For multi year funding requests, use the first year for which funding will be requested on Line 1. Rural Health Care Program I 2013 HCF Program Training 28 14
FCC Form 461: Block 3 Block 3: Consortium Request for Services Line 14: List the HCP numbers for all eligible and ineligible sites participating in this request for services. Rural Health Care Program I 2013 HCF Program Training 29 FCC Form 461: Block 3 Block 3: Consortium Request for Services Line 15: Indicate whether a request for proposals (RFP) will be submitted. Line 15a: If submitting an RFP, indicate why Line 15b: Requested contract period Line 15c: Expected time period to evaluate bids after the close of the posting period (after the ACSD ) Rural Health Care Program I 2013 HCF Program Training 30 15
FCC Form 461: Block 3 Block 3: Consortium Request for Services Line 16: Indicate how long the FCC Form 461 should be posted May enter number of days or a posting end date Posting end date will change based on when USAC actually posts the request services Recommendation: Use number of days to post either selection must provide for a minimum of 28 days An applicant can sign a contract after the posting closes (the Allowable Contract Selection Date (ACSD)) Rural Health Care Program I 2013 HCF Program Training 31 FCC Form 461: Block 3 Block 3: Consortium Request for Services Line 17: Select the appropriate category of expense. Applicants can select more than one category of expense. Line 17a If requesting only infrastructure, enter the FCC Form 461 application number in which the consortium also solicited bids for leased/tariffed services. Rural Health Care Program I 2013 HCF Program Training 32 16
FCC Form 461: Block 3 Block 3: Consortium Request for Services Line 18: Provide a brief summary of the RFP: If the consortium is not submitting an RFP, provide a description of services sufficient to enable the competitive bidding process. USAC always recommends consortia utilize an RFP. Rural Health Care Program I 2013 HCF Program Training 33 FCC Form 461: Block 3 Block 3: Consortium Request for Services Line 19: Identify primary point of contact for potential service providers, who can provide technical details and answer questions about requested services The point of contact may be the project coordinator, assistant project coordinator, or other (must then provide required contact information) Rural Health Care Program I 2013 HCF Program Training 34 17
FCC Form 461: Block 4 Block 4: Declaration of Assistance Indicate if any consultants, service providers, or other outside experts aided in the preparation of the FCC Forms 460, 461, RFP, and/or bid evaluation, or network plan on Line 20. If yes, Provide their contact information on Line 21. Rural Health Care Program I 2013 HCF Program Training 35 FCC Form 461: Block 5 Block 5: Bid Evaluation List all criteria that will be used to demonstrate how the most cost effective bid will be selected. Assign a weight to each. If there is an RFP, criteria must be included in the RFP. Rural Health Care Program I 2013 HCF Program Training 36 18
FCC Form 461: Block 5 Block 5: Bid Evaluation Price must be a primary factor, but need not be the only factor. No other factor may be weighted greater than price. Other criteria could include bandwidth, reliability, technical support, previous experience, etc. Rural Health Care Program I 2013 HCF Program Training 37 FCC Form 461: Block 6 Block 6: Additional Documentation RFP Network plan Letters of Agency (if not already submitted) Rural Health Care Program I 2013 HCF Program Training 38 19
FCC Form 461: Block 7 Block 7: Certifications (and Signature) Certifications should be by an officer, director, or other authorized employee of the consortium leader. (Lines 24 30) Rural Health Care Program I 2013 HCF Program Training 39 FCC Form 461: Block 7 Block 7: Certifications (and Signature) Complete lines 31 38 with the information of the person authorized to submit the form for the consortium leader. Rural Health Care Program I 2013 HCF Program Training 40 20
Forms Overview FCC Form 462 Rural Health Care Program I 2013 HCF Program Training 41 FCC Form 462: Block 1 Block 1: General Information Funding year Lines 2 through 4 will auto populate Rural Health Care Program I 2013 HCF Program Training 42 21
FCC Form 462: Block 2 Block 2: Competitive Bidding Information Line 5: FCC Form 461 application number Line 6: Allowable Contract Sign Date Line 7: Number of service providers who bid Rural Health Care Program I 2013 HCF Program Training 43 FCC Form 462: Block 2 Block 2: Competitive Bidding Information Line 8: Request for competitive bid exemption Rural Health Care Program I 2013 HCF Program Training 44 22
FCC Form 462: Block 3 Block 3: Vendor Information Enter selected Service Provider Identification Number (SPIN) Applicant must submit a separate FCC Form 462 for each service provider Same service provider, multiple SPINS = multiple forms Rural Health Care Program I 2013 HCF Program Training 45 FCC Form 462: Blocks 4 and 5 Block 4: Type of Funding Request Block 5: Single Eligible Expense Request for Funding Consortia do not have to fill out Block 4 or Block 5 Rural Health Care Program I 2013 HCF Program Training 46 23
FCC Form 462: Block 6 Block 6: Network Cost Worksheet Complete Block 6 and the Network Cost Worksheet if you are seeking support for multiple expenses. The fields in Block 6 cannot be edited. Once you complete the Network Cost Worksheet, lines 29 and 30 will be calculated for you. Rural Health Care Program I 2013 HCF Program Training 47 FCC Form 462: Block 6 Block 6: Network Cost Worksheet Will be part of the FCC Form 462 Must include information for each participating entity; eligible and ineligible, must be reported. Column A: HCP Number Column B: Site Name Rural Health Care Program I 2013 HCF Program Training 48 24
FCC Form 462: Block 6 Block 6: Network Cost Worksheet Columns C H: Contract Information Column C: Contact ID assigned by USAC Column D: Friendly name assigned by applicant Column E: Date contract with service provider was signed Column F: Length of initial contract term Column G: Number of contract extensions Column H: Length of each optional extension Rural Health Care Program I 2013 HCF Program Training 49 FCC Form 462: Block 6 Block 6: Network Cost Worksheet Columns I P: Eligible Expense Information Column I: Billing Account Number Column J: Category of expense Column K: Expense type Column L: Explanation of eligible expense Note: NCW is not posted on USAC website Rural Health Care Program I 2013 HCF Program Training 50 25
FCC Form 462: Block 6 Block 6: Network Cost Worksheet Columns I P: Eligible Expense Information (cont d) Columns J and K: Category of Expense and Expense Type Network Design Network Equipment owned and leased Routers, firewalls, switches, servers Includes maintenance contracts for equipment Infrastructure/outside plant owned by HCP Leased/tariffed facilities Irrevocable Right of Use Pre paid lease Network management/maintenance/operations costs Rural Health Care Program I 2013 HCF Program Training 51 FCC Form 462: Block 6 Columns I P: Eligible Expense Information (cont d) Column L: Explanation of Eligible Expense Provide information about exactly what the service/widget is: Example: Network switch to be used to make broadband service functional for eastern HCPs on network Example: Point to cloud connection for MPLS network Do not write, because the Order says it is eligible. Rural Health Care Program I 2013 HCF Program Training 52 26
FCC Form 462: Block 6 Columns I P: Eligible Expense Information (cont d) Column M O: broadband connection speed information Column P: expected date service will start, the network equipment will ship to the customer, or the work will be completed as an eligible expense Rural Health Care Program I 2013 HCF Program Training 53 FCC Form 462: Block 6 Block 6: Network Cost Worksheet Columns Q U:Quality of Service Guarantees Applicant should fill this section out if applicant s contract with vendor includes a Service Level Agreement (SLA) Rural Health Care Program I 2013 HCF Program Training 54 27
FCC Form 462: Block 6 Block 6: Network Cost Worksheet Columns V Z: Circuit information Rural Health Care Program I 2013 HCF Program Training 55 FCC Form 462: Block 6 Columns V Z: Circuit Information (cont d) Column V: Circuit ID, provide if available Column W: Physical location of where circuit will begin Column X: Physical location of where circuit will end One point of the connect must touch an eligible HCP; data center or administrative office to be eligible for funding Rural Health Care Program I 2013 HCF Program Training 56 28
FCC Form 462: Block 6 Columns V Z: Circuit Information (cont d) Column Y: If applicable, provide the total number of fiber strands. This should be filled out only when fiber strands are being purchased/leased. This does not need to be filled out if a service provider is providing recurring services. Column Z: If data is provided in Column Y, then Column Z must be completed (number of fiber strands eligible for support). Rural Health Care Program I 2013 HCF Program Training 57 FCC Form 462: Block 6 Block 6: Network Cost Worksheet Columns AA AI: Financial Information Column AA: Quantity of items requested If applicant is requesting support for a single connection (i.e. circuit); enter 1 If two routers; enter 2 Column AB: Indicate whether applicant is seeking a multi year commitment (Yes/No) Rural Health Care Program I 2013 HCF Program Training 58 29
FCC Form 462: Block 6 Block 6: Network Cost Worksheet Columns AA AI: Financial Information Column AC: Select how frequently the applicant will be billed by the vendor Quantity of expense period: the number of expense periods for which (one time, monthly, quarterly, semi annual, annual, etc.) the applicant is requesting funding Rural Health Care Program I 2013 HCF Program Training 59 FCC Form 462: Block 6 Block 6: Network Cost Worksheet Columns AA AI: Financial Information Column AE: Undiscounted price, per item, per expense period If total undiscounted price is $100.00, enter $100.00 Column AF: Percentage of expense eligible If entire expense is eligible, enter 100 percent Column AG: Percentage of usage eligible Column AH: Total eligible undiscounted costs calculated by USAC Column AI: Source of HCP contribution Rural Health Care Program I 2013 HCF Program Training 60 30
FCC Form 462: Block 6 Eligible Source of HCP Match Funds from the applicant or eligible HCP participants State grants, funding, or appropriations Federal funding, grants, loans, or appropriations Except for other universal service funding Tribal government funding Other grant funding, including private grants Rural Health Care Program I 2013 HCF Program Training 61 FCC Form 462: Block 7 Block 7: Additional Documentation Competitive bidding documents: Upload by service provider as a single document for the competitive bid response (do not upload multiple documents) Written description of cost allocation (if applicable) Contract: Upload main document and all attachments as a single document Rural Health Care Program I 2013 HCF Program Training 62 31
FCC Form 462: Block 8 Block 8: Request for Confidentiality Line 32: Requests for confidentiality are determined by the FCC on a case by case basis Rural Health Care Program I 2013 HCF Program Training 63 FCC Form 462: Block 9 Block 9: Certifications Must be signed by an officer, director, or other authorized employee of the consortium leader Rural Health Care Program I 2013 HCF Program Training 64 32
FCC Form 462: Block 9 Block 9: Certifications Rural Health Care Program I 2013 HCF Program Training 65 FCC Form 462: Block 9 Block 9: Certifications Rural Health Care Program I 2013 HCF Program Training 66 33
FCC Form 462: Block 9 Block 9: Signature Rural Health Care Program I 2013 HCF Program Training 67 Forms Walkthrough FCC Form 463 Rural Health Care Program I 2013 HCF Program Training 68 34
FCC Form 463 Purpose Serves as the request to USAC for the disbursement of funding for services, equipment, and/or facilities set forth in the applicant s funding commitment letter Certifies HCP has made required 35 percent contribution from eligible sources of funds FCC Form 463 is filed jointly by the applicant and the service provider Rural Health Care Program I 2013 HCF Program Training 69 FCC Form 463 When to File The FCC Form 463 may only be submitted after: A funding commitment is received, Service has begun/equipment installed, and The HCP/consortium has been billed by the service provider. Applicant and service provider must file the FCC Forms 463 within six months after the end date of the funding commitment Rural Health Care Program I 2013 HCF Program Training 70 35
FCC Form 463: Block 1 Block 1: General Information Line 1: RHC invoice number is generated by USAC Line 2: Enter Funding Request Number (FRN) contained in the funding commitment All remaining line items will pre populate, except Lines 6 and 9. Rural Health Care Program I 2013 HCF Program Training 71 FCC Form 463: Block 1 Block 1: General Information Line 6: Enter Applicant Invoice Number if desired Line 9: Amount USAC will pay the service provider for the services on the invoice Amount is calculated based on values contained in the FCC Form 463 Rural Health Care Program I 2013 HCF Program Training 72 36
FCC Form 463: Block 2 Block 2: Eligible Expenses Select the Funding Request ID (FRN ID) in Column A (found in the funding commitment letter) FRN ID is a separate and unique identifier associated with each line item for which the applicant is seeking support Rural Health Care Program I 2013 HCF Program Training 73 FCC Form 463: Block 2 Block 2: Eligible Expenses (cont d) Once FRN ID is entered, complete remaining columns (using information contained in FCC Form 462) Must be an FRN that is associated with FRN in Block 1 Rural Health Care Program I 2013 HCF Program Training 74 37
FCC Form 463: Block 3 Block 3: Dates, Quantities, and Costs Column H: Enter service start date, the date the equipment was shipped to the customer, or the last day work was completed. Columns I and J: Enter the first and last date of the billing period for this invoice. If it is a non recurring expense, enter N/A. Rural Health Care Program I 2013 HCF Program Training 75 FCC Form 463: Block 3 Block 3: Dates, Quantities, and Costs Column K: Enter the numeric quantity of items billed. Column L: Enter the actual total undiscounted cost for the billing period. If the applicant is invoicing for a single month of recurring service, the applicant should enter the total actual cost for service including taxes or surcharges. Rural Health Care Program I 2013 HCF Program Training 76 38
FCC Form 463: Block 4 Block 4: Calculation of Support Columns M and N: Information in these columns will be pre populated based on the FRN ID information Column O: Automatically calculated by multiplying columns L by M, and by column N of the FCC Form 463 Rural Health Care Program I 2013 HCF Program Training 77 FCC Form 463: Block 4 Block 4: Calculation of Support Column P: Total amount that USAC will pay for this line item Calculated by multiplying Column O by the discount percentage, as specified on the funding commitment Rural Health Care Program I 2013 HCF Program Training 78 39
FCC Form 463: Block 4 Block 4: Calculation of Support Sum of line items in column P are shown in Line 9: Total Invoice Amount (located in Block 1) USAC will pay the lesser of (per line item): Value calculated in Column P; or Support amount for the billing period specified in the FCL Rural Health Care Program I 2013 HCF Program Training 79 FCC Form 463: Block 5 Block 5: Supporting Documentation Line 10: Applicants and service providers may attach supporting documentation, including, but not limited to, copies of bills for the line items being submitted. Submitting supporting documentation will ensure that such information is available for any future audit. Rural Health Care Program I 2013 HCF Program Training 80 40
FCC Form 463: Block 7 Block 7: Applicant Certifications and Signatures Rural Health Care Program I 2013 HCF Program Training 81 FCC Form 463: Block 7 Block 7: Applicant Certifications and Signatures Each certification must be completed by representative of consortium leader, including: Information on FCC Form 463 is true and correct Consortium members have received related services, network equipment, and facilities itemized on FCC Form 463 Rural Health Care Program I 2013 HCF Program Training 82 41
FCC Form 463: Block 7 Block 7: Applicant Certifications and Signatures (cont d) Each certification must be completed by representative of consortium leader, including: Verification that 35 percent minimum contribution was funded by eligible sources and that required contribution was remitted to the service provider Rural Health Care Program I 2013 HCF Program Training 83 FCC Form 463: Block 7 Block 7: Applicant Certifications and Signatures Lines 26 33 normally are completed by an officer, director, or other authorized employee of the individual HCP or consortium leader (Block 4). Letter of authorization must be on record if not an employee of the HCP or consortium leader Rural Health Care Program I 2013 HCF Program Training 84 42
FCC Form 463: Block 6 Block 6: Vendor Certifications and Signatures Acknowledges that the service provider must credit health care providers and FRN/FRN IDs listed in this invoice Rural Health Care Program I 2013 HCF Program Training 85 FCC Form 463: Block 6 Block 6: Vendor Certifications and Signatures (cont d) Each certification must be completed and signed by an authorized representative of the service provider. Note: If revisions are made, the HCP must review and recertify the form before USAC can begin processing. Rural Health Care Program I 2013 HCF Program Training 86 43
FCC Form 463 Next Steps Once USAC has reviewed and approved the FCC Form 463, the service provider will receive payment either directly or as an offset to its universal service contribution. This designation is completed on the FCC Form 498. Rural Health Care Program I 2013 HCF Program Training 87 44