Application Process for Individual HCPs

HCF Program Training Application Process for Individual HCPs HCF Program Training I Application Process I September 2015 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.Section 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 HCF Program Training I Application Process I September 2015 2

Agenda 1. Program Overview 2. My Portal 3. Step 1: Before You Apply 4. Step 2: Determine Eligibility 5. Step 3: Prepare for Competitive Bidding 6. Step 4: Request Services 7. Step 5: Evaluate Bids and Select Service Provider 8. Step 6: Submit Funding Requests 9. Step 7: Prepare and Submit Invoice 10. Resources Available HCF Program Training I Application Process I September 2015 3

Program Overview Rural Health Care (RHC) Program Telecommunications Program Funds urban/rural rate difference for telecommunications services for rural health care providers (HCPs) Remained in place after Healthcare Connect Fund Program implementation Healthcare Connect Fund Program Supports broadband connectivity and broadband networks for eligible HCPs Provides 65 percent discount on eligible services and equipment HCF Program Training I Application Process I September 2015 4

Program Overview Rural Health Care (RHC) Program Internet Access Program (Part of Telecom Program) Provides a 25 percent discount on Internet access services for rural HCPs Ended June 30, 2014: Participants transitioning to the Healthcare Connect Fund Program Pilot Program Supports 50 state-wide and regional broadband HCP networks Participants transitioning to the Healthcare Connect Fund Program as Pilot Program funds are exhausted HCF Program Training I Application Process I September 2015 5

Program Overview Application Process 1. Determine Eligibility Must meet the three initial program criteria and make sure requested services are eligible 2. Develop Evaluation Criteria and Request Services Develop scoring criteria to evaluate bids and describe service needs (posted on USAC website) 3. Evaluate Bids & Select a Service Provider Choose the most cost-effective service provider HCF Program Training I Application Process I September 2015 6

Program Overview Application Process 4. Submit Funding Requests Provide information about services and selected service provider 5. Invoice Initiate invoicing process and submit to service provider for review HCF Program Training I Application Process I September 2015 7

Application Process HCF Order, Section VI Four FCC Forms: FCC Form 460 Registering and Determining Eligibility FCC Form 461 Requesting Services FCC Form 462 Requesting Funding Commitment FCC Form 463 Submitting Invoice HCF Program Training I Application Process I September 2015 8

HCF Program Training I Application Process I September 2015 9

Application Process HCF Order, Section VI Four FCC Forms: FCC Form 460 Processing Time: 30 days FCC Form 461 Processing Time: Without RFP 3-5 business days. With RFP, approximately 4 weeks. FCC Form 462 Processing Time: 60-90 days FCC Form 463 Processing Time: 30 days HCF Program Training I Application Process I September 2015 10

Application Process HCF Order, Section VI Processing Time Processing time is calculated from the date of receipt of a complete and accurate form, including all supporting documentation. Missing and inaccurate information will delay processing. Timeliness of responses to USAC requests for information affects processing time (applicants are required to provide a response to information requests within 14 calendar days). HCF Program Training I Application Process I September 2015 11

My Portal Create My Portal Account HCF Program Training I Application Process I September 2015 13

My Portal Create My Portal Account HCF Program Training I Application Process I September 2015 14

My Portal Create My Portal Account HCF Program Training I Application Process I September 2015 15

My Portal Primary Account Holder Add new account holder. HCF Program Training I Application Process I September 2015 16

My Portal Primary Account Holder Add new account holder. HCF Program Training I Application Process I September 2015 17

My Portal Primary Account Holder Edit user details HCF Program Training I Application Process I September 2015 18

My Portal Changing Account Holders In order to change the Primary Account Holder (PAH), an FCC Form 460 revision must be filed where a new PAH is named in Block 4. HCF Program Training I Application Process I September 2015 19

Step 1: Before You Apply Things to consider Decide whether to apply as an individual HCP or as a consortium. Get familiar with the application process. Submit third-party authorizations, if you are using a consultant. HCF Program Training I Application Process I September 2015 21

Step 2: Determine Eligibility 47 C.F.R. Section 54.600 1. Eligible Status Nonprofit OR Public HCF Program Training I Application Process I September 2015 23

Step 2: Determine Eligibility 2. Eligible Facility Type Not-for-profit hospitals Rural health clinics Community mental health centers Local health departments or agencies Post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools Community health centers or health centers providing health care to migrants Dedicated emergency departments of rural for-profit hospitals Part-time eligible entities Consortia of the above entities HCF Program Training I Application Process I September 2015 24

Step 2: Determine Eligibility Off-site Data Centers and Administrative Offices Connections and network equipment associated with off-site data centers or administrative offices used by eligible HCPs are eligible for support. However, off-site administrative offices and off-site data centers themselves are not eligible health care providers. 47 C.F.R. Section 54.637 HCF Program Training I Application Process I September 2015 25

Step 2: Determine Eligibility 3. Eligible Location Individual HCP applicants must be located in an FCC-approved rural location to be considered rural. There is a rural look-up tool located on the USAC website: www.usac.org/rhc/telecommunications/tools/rural /search/search.asp HCF Program Training I Application Process I September 2015 26

Eligible Services and Equipment Step 2: Determine Eligibility HCF Order, Section V HCF Program Training I Application Process I September 2015 27

Step 2: Determine Eligibility HCF Order, Section V Eligible Services and Equipment (Individual HCPs) Recurring charges for broadband services Reasonable and customary installation charges $5,000, undiscounted Equipment necessary to make service functional as long as the equipment is used in connection with broadband services funded through the HCF Program Connections to research and educational networks HCP connections between off-site data centers and administrative offices HCF Program Training I Application Process I September 2015 28

Step 2: Determine Eligibility HCF Order, Section V.C.3 Ineligible Expenses include: Administrative expenses, Equipment or services not directly associated with broadband services, for example: Medical equipment (hardware and software), such as telemedicine equipment, Expenses associated with general computing, software, applications, and Internet content development, and Inside wiring and internal connections. HCF Program Training I Application Process I September 2015 29

What is the FCC Form 460? Eligibility and Registration Form Step 2: Determine Eligibility HCF Order, Section VI.A.2 An individual applicant must file an FCC Form 460 for itself and a separate FCC Form 460 for any associated offsite administrative office or off-site data center. Eligibility must be determined before an FCC Form 461 (Requests for Services Form) can be reviewed. HCF Program Training I Application Process I September 2015 30

What is on the FCC Form 460? Site information Contact information Eligibility information Certifications and signatures Step 2: Determine Eligibility HCF Order, Section VI.A.2 HCF Program Training I Application Process I September 2015 31

FCC Form 460 Step 1: Log in Log into My Portal using your User ID and Password HCF Program Training I Application Process I September 2015 32

FCC Form 460 Step 2: View Landing Page Select Individual Applicant Healthcare Connect Fund (Forms 460, 461, 462, 463). HCF Program Training I Application Process I September 2015 33

FCC Form 460 Step 3: Initiate FCC Form 460 Creation After selecting the options for Individual Applicants, the applicant is directed to a page listing all HCPs filed by HCP Number and Name under the My HCPs tab. If an applicant has never filed for HCF support, this page will be blank. Select Create New Form 460 to initiate the eligibility process for the HCP site. HCF Program Training I Application Process I September 2015 34

FCC Form 460 Step 3: Initiate FCC Form 460 Creation HCF Program Training I Application Process I September 2015 35

FCC Form 460 Step 4: Conduct Zip Code Search To create an FCC Form 460, conduct a zip code search to make sure the HCP site is not already filed or existing in the program. Enter the zip code of the HCP site. Or search by HCP number (would use the same HCP number as Telecom if the applicant is already active in Telecom). HCF Program Training I Application Process I September 2015 36

FCC Form 460 Step 4: Conduct Zip Code Search Select Search to view any applicants in that zip code currently participating in the HCF Program. If there are no existing HCPs in that zip code, the search results will yield no existing HCPs and will prompt the applicant to select New HCP to begin the application process with a new HCP number. HCF Program Training I Application Process I September 2015 37

FCC Form 460 Step 5: Create FCC Form 460 HCF Program Training I Application Process I September 2015 38

FCC Form 460 Step 5: Create FCC Form 460 Once the applicant selects New HCP, a pop-up window will appear asking the applicant to select what they are applying for. In this example, Determine eligibility of an HCP site is selected. Once the choice for application type is selected, click the Create New Form 460 button. HCF Program Training I Application Process I September 2015 39

Step 6: Complete Physical Location Information The address information should correspond to the address information of applicant on the FCC Form 460. Line 6: The site s FCC RN can be found here: https://apps.fcc.gov/coresweb/publichome.do Line 7: The Site Contact should be an employee of the site and located at the site listed on Line 4 of the FCC Form 460. The site contact may be a part-time employee. Line 45: The EIN number is used to verify the non-profit status of the site or legal entity. All non-profit entities are assigned an EIN to designate the business as a non-profit entity. For questions on how to obtain this number or to reference the organization s EIN number, visit http://www.guidestar.org/. HCF Program Training I Application Process I September 2015 40

HCF Program Training I Application Process I September 2015 41

FCC Form 460 Step 7: Select Eligibility Category Complete Lines 43 and 44 to select an eligibility category for this HCP site. Line 43 offers dropdown options for the applicant to select an eligibility category that best suits the site listed on the FCC Form 460. Choose an appropriate entity type for this site from the dropdown options offered by Line 43. A list of eligible and ineligible facility types is listed on the USAC website for reference: (http://www.usac.org/rhcp/participants/eligibilty.aspx). HCF Program Training I Application Process I September 2015 42

FCC Form 460 Step 7: Select Eligibility Category Provide a brief description (less than 250 characters) of the services offered at the facility listed on the FCC Form 460. For example, if applying for a Rural Health Clinic, provide a description of the types of services offered (orthopedic, gynecological, pediatrics, cardiology, general care etc.) and the medical professionals on staff (Medical Doctors, Nurse Practitioners, Nurses, etc.). Once this information is complete, select Save and Continue. HCF Program Training I Application Process I September 2015 43

FCC Form 460 Step 8: Enter Account Holder Information The Secondary Account Holder must be an officer, director, or authorized employee of the HCP or legal entity that owns the site listed for this FCC Form 460. The PAH is available to answer any questions related to the FCC Form 460 or the site listed on the form. The PAH will receive all information related to the FCC Form 460 and its status as approved/denied/withdrawn as the review of the form is completed. The person that uses the account the most should be the PAH. HCF Program Training I Application Process I September 2015 44

FCC Form 460 Step 8: Enter Account Holder Information HCF Program Training I Application Process I September 2015 45

FCC Form 460 Secondary Account Holder If there is a Secondary Account Holder, select the box for Secondary Account Holder. The Secondary Account Holder must be an officer, director, or authorized employee of the HCP or legal entity that owns the site listed for this FCC Form 460. HCF Program Training I Application Process I September 2015 46

FCC Form 460 Enter Additional Information Complete Lines 46-50 with information pertaining to the applicant s status as a public or not-for-profit healthcare provider. The National Provider Identifier (NPI) is a unique 10-digit identification number issued to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). All participating HCPs should have this number on file. HCF Program Training I Application Process I September 2015 47

FCC Form 460 Enter Additional Information The Organization Taxonomy code is a specialty code used by healthcare providers to indicate their specialty as a designated healthcare provider. The Site Taxonomy code is necessary if the site has its own specialty provider code that is separate from a health system or organization provider code. For example, if the office provides Orthopedic services but is sponsored by a major hospital. The hospital will have its own organization taxonomy code, but the clinic will also have a taxonomy code based on the specialty care offered at this location. HCF Program Training I Application Process I September 2015 48

FCC Form 460 Enter Additional Information Line 50 is a selection of boxes that can be selected if the location of the provider is on Tribal lands, Operated by the Indian Health Service or Otherwise Affiliated with a Tribe. Please make any appropriate selections. If none of these apply, select N/A. HCF Program Training I Application Process I September 2015 49

FCC Form 460 Initiate Certification Under the Certifications tab, use the following steps to certify the FCC Form 460. To certify, complete Lines 53 through 57 to verify the user is authorized to submit the form. Once the certifications are complete, select Save and Continue. HCF Program Training I Application Process I September 2015 50

FCC Form 460 Step 10: Sign and Certify Enter Signature. The signature will be the password used to enter the portal. Note: The information in the Signature block is prepopulated based on the account information for the user. HCF Program Training I Application Process I September 2015 51

FCC Form 460 Step 10: Sign and Certify If the person signing the form is a third party (i.e. consultant, outside expert, etc.), the system will prompt the applicant to upload a Third Party Authorization (TPA) document. This will appear if the Primary Account Holder differs from the person providing the signature for the form. To upload a TPA, select the option to Click to Upload and insert a TPA document into this space. The TPA effective start date and end date must also be provided. More information regarding the TPA is available on the RHC Program website. HCF Program Training I Application Process I September 2015 52

FCC Form 460 Step 10: Sign and Certify Once this information is complete, select Certify. The applicant s My Portal password will act as the signature for this Certification block. HCF Program Training I Application Process I September 2015 53

FCC Form 460 Step 10: Sign and Certify If the HCP is being filed as a member of the consortium, the form will not be delivered to the USAC review queue until an LOA is submitted for the HCP. The LOA must be submitted within 15 days of the Form 460 being submitted to USAC. If the LOA is not submitted within 15 days, the Form 460 will be automatically denied. More information regarding the LOA and how to submit the LOA is available on the RHC Program website. HCF Program Training I Application Process I September 2015 54

Step 3: Prep for Competitive Bidding HCF Order, Section VI.B.6 Competitive Bidding Process Exemptions Include: An annual undiscounted cost less than or equal to $10,000, Purchasing from a government-negotiated Master Services Agreement (MSA). MSAs approved under the Pilot Program or HCF Program, A multi-year contract deemed evergreen by USAC, or Contracts negotiated under the E-rate Program (Schools and Libraries Program). Competitive bidding is initiated with the submission of the FCC Form 461. HCF Program Training I Application Process I September 2015 56

Step 3: Prep for Competitive Bidding What is an evergreen contract? HCF Order, Section VI.B.6.d If USAC has designated a multi-year contract as evergreen, then for the life of the contract, applicants do not need to annually re-bid the service or post an FCC Form 461 (47 CFR, Section 54.642(h)(4)). HCF Program Training I Application Process I September 2015 57

Step 3: Prep for Competitive Bidding HCF Order, Section VI.B.6.d What is an evergreen contract? (cont d) A new contract can be designated as evergreen if it meets all of the following criteria: Signed by the applicant Specifies service type, bandwidth, and quantity Specifies term of the contract Specifies cost of services to be provided Includes the physical address or other identifying information of the applicants purchasing from the contract HCF Program Training I Application Process I September 2015 58

Step 3: Prep for Competitive Bidding HCF Order, Section VI.B.6.d Voluntary Extensions (47 C.F.R. Section 54.642(h)(4)(iii)) Participants may exercise voluntary contract extensions without undergoing additional competitive bidding if: The voluntary extension is memorialized in the evergreen contract, The decision to extend the contract occurs before the participant files its funding request for the funding year when the contract would otherwise expire, and The voluntary extension(s) do not exceed five years in the aggregate. HCF Program Training I Application Process I September 2015 59

Step 3: Prep for Competitive Bidding HCF Order, Section VI.A.4 Most Cost-Effective All applicants must seek competitive bids for supported services. All applicants must certify that they have selected the most cost-effective bid on their requests for funding (unless they qualify for a competitive bidding exemption). HCF Program Training I Application Process I September 2015 60

Step 3: Prep for Competitive Bidding HCF Order, Section VI.A.4 What does most cost effective mean? [ ] The method that costs the least after consideration of the features, quality of transmission, reliability, and other factors that the HCP deems relevant to choosing a method of providing the required health care services (47 C.F.R. Section 54.642(c)). Cost must be a primary factor. No single factor may receive a weight that is greater than price, although another factor may receive the same weight as price. HCF Program Training I Application Process I September 2015 61

Step 3: Prep for Competitive Bidding HCF Order, Section VI.A.4 Evaluation Criteria Applicants must certify that they have selected the most cost-effective bid on their request for funding. Applicants are required to establish evaluation criteria. Cost (price) of service must be a primary factor No criteria can be weighted higher than cost, but it can be weighted equal to cost Total weight must equal 100 percent Criteria should include most important criteria needed to provide healthcare, as determined by the applicant HCF Program Training I Application Process I September 2015 62

Step 3: Prep for Competitive Bidding HCF Order, Section VI.A.4 Sample Evaluation Criteria Some HCPs may find the following criteria to be useful in determining the most cost-effective bid: Price Bandwidth Quality of transmission Reliability Prior experience with the service provider Technical support HCF Program Training I Application Process I September 2015 63

Step 4: Request Services HCF Order, Section VII.B Duplicate Funding Requests Applicants cannot request support for the same service from the Telecommunications and HCF programs. HCF Program Training I Application Process I September 2015 65

Step 4: Request Services HCF Order, Section VII.B What is the FCC Form 461? The Request for Services Form Initiates the competitive bidding process, Must be posted on USAC s website for at least 28 days, Provides information about requested services and network equipment to enable an effective competitive bidding process, and Can be submitted starting 180 days before the beginning of the funding year. HCF Program Training I Application Process I September 2015 66

FCC Form 461 (Individual HCP Applicants) Step 4: Request Services HCF Order, Section VI.A.4 USAC will post the applicant s request for services on the USAC website. The posting includes: The FCC Form 461, and A request for proposals (if applicable). HCF Program Training I Application Process I September 2015 67

When is an RFP required? Step 4: Request Services HCF Order, Section VI.B.2 An RFP is required when State, Tribal, or local procurement rules or regulations require it, or if applicant is requesting $100,000 or more per year in discounted support; Any applicant can also choose to utilize an RFP in conjunction with their competitive bidding process. HCF Program Training I Application Process I September 2015 68

Fair and Open Process Step 4: Request Services HCF Order, Section VI.B.1 Service providers that intend to bid are prohibited from: Preparing, signing, or submitting an applicant s FCC Form 461 and supporting documents; Serving as point of contact on behalf of applicants; Being involved in setting bid evaluation criteria; and Participating in the bid evaluation or service provider selection process (except in their role as a potential service provider). HCF Program Training I Application Process I September 2015 69

Fair and Open Process Step 4: Request Services HCF Order, Section VI.B.1 Consultants, other third-party experts, or applicant employees who have an ownership interest, sales commissions arrangement, or other financial stake with respect to a bidding service provider are also prohibited from performing any of the four functions previously outlined on behalf of the applicant. HCF Program Training I Application Process I September 2015 70

Fair and Open Process Step 4: Request Services HCF Order, Section VI.A.4 All potential bidders must have access to the same information and must be treated in the same manner. If an applicant modifies anything on any documents posted by USAC, the applicant must notify all potential bidders at the same time using a uniform method. Applicants are required to immediately notify USAC of the modification. USAC will modify the original posting accordingly. All applicants and service providers must comply with any applicable state or local competitive bidding requirements. HCF Program Training I Application Process I September 2015 71

Step 4: Request Services HCF Order, Section VI.B.3 Declaration of Assistance Applicants are required to identify any consultants, service providers, or any other outside experts who aided in the preparation of the FCC Form 461 and supporting documentation. Paid or unpaid FCC Form 461, Block 4 HCF Program Training I Application Process I September 2015 72

FCC Form 461 Step 1: Log in Log into the system using User ID and Password HCF Program Training I Application Process I September 2015 73

FCC Form 461 Select HCP HCF Program Training I Application Process I September 2015 74

FCC Form 461 Select Create FCC Form 461 HCF Program Training I Application Process I September 2015 75

FCC Form 461 Fill Out General Information Most information aside from the Funding Year and Friendly Name will pre-populate Note: For multi-year funding requests, use the first year for which service is sought on Line 1. HCF Program Training I Application Process I September 2015 76

Upload RFP and Enter Requested Contract Period Line 10: Indicate that a Request for Proposals (RFP) will not be prepared and submitted. Line 10a: Enter the requested contract period Line 10b: Enter the expected time period to be used to evaluate bids Line 11: Indicate how long HCP s Form 461 should be posted on USAC s web site. May enter number of days or a posting end date Either selection must provide for a minimum of 28 days. FCC Form 461 HCF Program Training I Application Process I September 2015 77

Upload RFP and Enter Requested Contract Period FCC Form 461 HCF Program Training I Application Process I September 2015 78

FCC Form 461 Complete Site Request for Services Select one or both Category of Expenses HCF will not cover certain expenses related to network equipment or leased facilities for individual HCP applicants HCF Program Training I Application Process I September 2015 79

FCC Form 461 Line 12a HCF Program Training I Application Process I September 2015 80

FCC Form 461 Complete Site Request for Services Line 13: Identify the primary point of contact for potential vendors, who can provide technical details and answer questions about the requested services. The point of contact may be: Physical location contact Primary account holder Other HCF Program Training I Application Process I September 2015 81

FCC Form 461 Declaration of Assistance If no consultant, service provider or outside expert helped in the preparation of your Form 461, network plan, etc. select No and Save and Continue HCF Program Training I Application Process I September 2015 82

FCC Form 461 Declaration of Assistance If yes, select Yes and New Contact and fill out the information before selecting Save and Continue. HCF Program Training I Application Process I September 2015 83

FCC Form 461 Bid Evaluation List all criteria used to demonstrate how the most costeffective bid will be selected. Assign a weight to each. Cost must be a primary factor No other factor may be weighted higher than cost Examples of other criteria could include bandwidth, reliability, technical support, previous experience with service provider, etc. HCF Program Training I Application Process I September 2015 84

FCC Form 461 Bid Evaluation HCF Program Training I Application Process I September 2015 85

FCC Form 461 Bid Evaluation Add weight value, and select New Criterion to add new criterion until the weights equal 100%. HCF Program Training I Application Process I September 2015 86

FCC Form 461 Supporting Documentation Upload additional supporting documentation (like a network plan) by selecting New Document. HCF Program Training I Application Process I September 2015 87

FCC Form 461 Supporting Documentation Once uploaded, select Save and Continue. HCF Program Training I Application Process I September 2015 88

FCC Form 461 Certification Check all boxes and select Save and Continue. HCF Program Training I Application Process I September 2015 89

FCC Form 461 Certification Select Certify and then enter your signature in the pop up box (which is your My Portal Password). HCF Program Training I Application Process I September 2015 90

FCC Form 461 Return to Queue You will be notified that the form was submitted and returned to your queue. HCF Program Training I Application Process I September 2015 91

Step 5: Evaluate Bids, Select SP HCF Order, Section VI.B.4 Allowable Contract Selection Date Applicants must post for services for a minimum of 28 calendar days. Applicants can choose to post for longer than 28 days. USAC will post for the length of time requested by the applicant if longer than 28 days. Allowable Contract Selection Date (ACSD) is the first day that the applicant can choose a service provider. HCF Program Training I Application Process I September 2015 93

Step 5: Evaluate Bids, Select SP HCF Order, Section VI.A.4 Evaluation Use of scoring matrix with weights assigned to evaluation criteria Selection of most cost effective HCF Program Training I Application Process I September 2015 94

Step 6: Submit Funding Requests HCF Order, Section VI.C.3 What is the FCC Form 462? The Funding Request Form Provides USAC with information necessary to evaluate an applicant s funding request Must be submitted before the end of the funding year (June 30) Applicants can seek a multi-year funding commitment Applicants can file for multiple services on a single form HCF Program Training I Application Process I September 2015 96

Step 6: Submit Funding Requests What is on the FCC Form 462? Competitive bidding information and documentation Service provider information Funding request information Cost allocation documentation (if applicable) Certifications and signatures HCF Program Training I Application Process I September 2015 97

Before You Begin the FCC Form 462 Step 6: Submit Funding Requests HCF Order, VI.C.3 Have a copy of the bill (from the current funding year) for each circuit available Have a copy of the contract available Review the FCC Form 462 to ensure you can answer the detailed questions about each expense Be able to identify the source of the 35 percent contribution Any installation charges must be identified in the bill Be prepared to upload a copy of bids received, the contract, bill(s), and other supporting documentation HCF Program Training I Application Process I September 2015 98

FCC Form 462 Step 1: Log in Log into My Portal using your User ID and password HCF Program Training I Application Process I September 2015 99

FCC Form 462 Select HCP HCF Program Training I Application Process I September 2015 100

FCC Form 462 Select HCP Under the Form 461 tab, select Create 462 by desired FRN. HCF Program Training I Application Process I September 2015 101

FCC Form 462 Create FCC form 462 Select single eligible expense or multiple eligible expense for the FCC Form 462 (in this example, we will do a multiple expense). HCF Program Training I Application Process I September 2015 102

FCC Form 462 General Information This pre-populates and cannot be changed. Select Save and Continue. HCF Program Training I Application Process I September 2015 103

FCC Form 462 SPIN Search Click Search for a SPIN to find the appropriate SPIN for the FRN. HCF Program Training I Application Process I September 2015 104

FCC Form 462 SPIN Search Select the correct SPIN and the information will automatically populate for Lines 9-11. HCF Program Training I Application Process I September 2015 105

FCC Form 462 Competitive Bidding Information Lines 5-6 prepopulate. Line 7: Enter the number of bids received from service providers (you will need to submit copies with the form). HCF Program Training I Application Process I September 2015 106

FCC Form 462 Competitive Bidding Information If claiming competitive bid exemption, select which type, and upload contract if necessary. If Evergreen Contract is selected, click Add Contract and pick from list of available contracts. HCF Program Training I Application Process I September 2015 107

FCC Form 462 Contract Information HCF Program Training I Application Process I September 2015 108

Request for Funding FCC Form 462 Line I: Provide the Billing Account Number (BAN) Line J: Select on of the two expense categories Line K: Select expense type from drop down menu Line L: Provide explanation of expense Lines M-O: If upload/download speeds are the same, it is symmetrical Line P: Day that service was actually activated HCF Program Training I Application Process I September 2015 109

FCC Form 462 Request for Funding Lines V-X: Circuit that starts or ends at an HCP One of these should be the HCP address listed on the FCC Form 460 (prepopulated). Please insure the address or HCP name is listed on the supporting documentation by the service provider. HCF Program Training I Application Process I September 2015 110

FCC Form 462 Request for Funding Line AB: If seeking a multi-year funding commitment, check yes here Not available if skipping competitive bidding for >$10,000 Line AC: Expense frequency is how often you plan to submit invoices Line AD: How many times will you invoice? If Line AB: yes, this is Line AC x length of funding commitment (i.e. three year funding commitment times quarterly invoicing = 12 invoices) Line AE: The total amount being requested per invoice HCF Program Training I Application Process I September 2015 111

FCC Form 462 Request for Funding Line AF: Enter 100% if the entire cost is eligible. If some costs are ineligible, provide a break out of the costs. Line AG: If the circuit is used only for an eligible HCP and solely for the provision of health care, enter 100%. If the circuit is shared with an ineligible entity, provide the percent used by the eligible HCP. If the circuit is used part-time for non-health care related uses, provide the percent for health care. HCF Program Training I Application Process I September 2015 112

FCC Form 462 Request for Funding Line AI: Where are you getting the funds for the 35 percent? HCF Program Training I Application Process I September 2015 113

FCC Form 462 Add another expense Select Add Expense to add another expense and fill out all the fields for that expense. HCF Program Training I Application Process I September 2015 114

FCC Form 462 Add another expense Lines 29-30 will pre-populate based on information filled out for each expense. HCF Program Training I Application Process I September 2015 115

FCC Form 462 Additional Documentation Select New Document to upload any additional supporting documentation (Competitive bids received, contract, etc.). You can select the document type with the drop-down menu. HCF Program Training I Application Process I September 2015 116

FCC Form 462 Certifications HCF Program Training I Application Process I September 2015 117

FCC Form 462 Sign Make sure all information is correct and sign using your password to log into My Portal. HCF Program Training I Application Process I September 2015 118

FCC Form 462 After Submitting You will be returned to the forms queue. HCF Program Training I Application Process I September 2015 119

FCC Form 462 After Submitting Once the form has been approved, the account holders will receive a Funding Commitment Letter (FCL). This document will include: Funding Start and End Date Total Approved Funding for the Invoicing Deadline Date (FCC Form 463) HCF Program Training I Application Process I September 2015 120

FCC Form 462 Example FCL HCF Program Training I Application Process I September 2015 121

Step 7: Prepare and Submit Invoice HCF Order VI.D What is the FCC Form 463? The Invoice and Request for Disbursement Form Serves as a request to USAC for disbursement of funding from the HCF Program for services and equipment. Filing the FCC Form 463 is a joint process between the applicant and service provider. The applicant initiates the submission of the form and submits the form to the service provider who approves or rejects the form. HCF Program Training I Application Process I September 2015 123

Step 7: Prepare and Submit Invoice What is the FCC Form 463? The Invoice and Request for Disbursement Form may only be submitted after (cont d): The applicant has submitted its 35 percent contribution to the service provider, and The service provider and applicant certify and sign the FCC Form 463. The FCC Form 463 must be filed within six months after the end date of the funding commitment. HCF Program Training I Application Process I September 2015 124

Step 7: Prepare and Submit Invoice HCF Order VI.D When to submit the FCC Form 463? The Invoice and Request for Disbursement Form may only be submitted after: The applicant receives a funding commitment, The service provider has installed or started services, network equipment, and facilities, if applicable, and The applicant has received a bill from the service provider. HCF Program Training I Application Process I September 2015 125

FCC Form 463 Step 1: Log in HCF Program Training I Application Process I September 2015 126

FCC Form 463 Step 2: Select Individual Applicant HCF Program Training I Application Process I September 2015 127

Select HCP After selecting the options for Individual Applicant, the applicant is directed to a page listing all HCPs filed by HCP Number and name under the My HCPs tab. Select an HCP number/name to file an FCC Form 463. HCF Program Training I Application Process I September 2015 128

Select FRN Select Form 462 tab in to view FRNs associated with selected HCP. Find the FRN to invoice with the FCC Form 463. Select the Create 463 button on the line associated with the desired FRN(s). HCF Program Training I Application Process I September 2015 129

FCC Form 463 Step 3: Complete General Information Complete Line 6: Vendor/Applicant Invoice Number. The Vendor/Applicant Invoice Number is a field the applicant may customize with a friendly name or a name that is easy to remember or for record keeping needs. This is not a required field, but it is recommended so the applicant may complete it with a friendly name for the invoice. Select Save and Continue. Note: Lines 1-5 and 7-8 prepopulate based on information provided on the FCC Form 462. These fields cannot be modified. HCF Program Training I Application Process I September 2015 130

FCC Form 463 Step 3: Complete General Information HCF Program Training I Application Process I September 2015 131

FCC Form 463 Step 4: Search and Select FRN Select Add to choose the FRN(s) line item for this invoice HCF Program Training I Application Process I September 2015 132

FCC Form 463 Step 4: Search and Select FRN Note: FRNs will be labeled by line item numerical order and not by FRN number. In this example, the FRN IDs selected above are 2 and 4 because these are the only line items for which the applicant wishes to invoice at this time. It is not necessary invoice for all FRN IDs; select only the IDs (line items) for which you wish to invoice for at this time. HCF Program Training I Application Process I September 2015 133

FCC Form 463 Step 4: Search and Select FRN After the FRN ID number(s) have been selected, click Save and Continue. HCF Program Training I Application Process I September 2015 134

FCC Form 463 Step 5: Enter Billing Information All previously selected FRN IDs will appear on this screen. Note: Columns A through G and M through P are pre-populated line items, based on information selected on FCC Form 462. HCF Program Training I Application Process I September 2015 135

FCC Form 463 Step 5: Enter Billing Information Tip: Continue to scroll to the right side of the screen to view all available columns. The first time an FCC Form 463 is created, the date indicated for the Service Start Date (Column H) will automatically pre-populate on the FCC Form 462. HCF Program Training I Application Process I September 2015 136

Step 5: Enter Billing Information Scroll to the right side of the page to enter information for columns H through L. Column H: Service Start Date/Shipping Date or Last Day of Work Column I: Billing Period Start Date The earliest date you may input is your Funding Start Date as found on the Funding Commitment Letter. All subsequent invoices may not overlap Billing Periods. Column J: Billing Period End Date The latest date you may input here is your Funding End Date as found on the Funding Commitment Letter. Column K: Quantity of Items Invoiced Column L: Total Cost Invoiced (Undiscounted) FCC Form 463 Undiscounted Recurring Expense (As found on your FCL) x the number of months being invoiced HCF Program Training I Application Process I September 2015 137

FCC Form 463 Step 5: Enter Billing Information Complete FCC Form 463 for as many billing periods as needed, but be sure payment is not requested for future service dates. Invoices should be submitted in chronological order. We recommend that you submit large invoices spanning whole months, years, or commitment periods rather than small partial month invoices. This allows the applicant to maintain an organized record of previously approved support periods in order to avoid over-lapping invoices and denials. For requests more than one month of service, enter the total cost undiscounted in Column L. The system will not calculate the cost based on dates previously entered. HCF Program Training I Application Process I September 2015 138

FCC Form 463 Step 5: Enter Billing Information HCF Program Training I Application Process I September 2015 139

FCC Form 463 Step 5: Enter Billing Information Tip: If any of these items are incomplete, an error message will appear at the bottom of the screen. The number in parentheses at the beginning of the error message indicates the line item containing the error. Continue scrolling to the right side of the page to view Columns M through P. These items are pre-populated based on the information entered for the FCC Form 462. HCF Program Training I Application Process I September 2015 140

FCC Form 463 Step 5: Enter Billing Information Once the information for these line items is complete, click Save and Continue. HCF Program Training I Application Process I September 2015 141

Step 6: Upload Supporting Documentation FCC Form 463 Applicants may upload supporting documentation, but is not a requirement. Generally, supporting documentation may include a vendor bill, correspondence with a service provider, or spreadsheet used by each project to breakdown expenses by line item. If you have no documents to upload, click Save and Continue. HCF Program Training I Application Process I September 2015 142

Step 6: Upload Supporting Documentation FCC Form 463 If you would like to upload supporting documentation, select New Document. You will be prompted to Click to Upload the document. Once the file has been uploaded, provide a description of the document and then click Save and Continue. HCF Program Training I Application Process I September 2015 143

FCC Form 463 Step 7: Initiate Certifications Under the Certifications tab, use the following steps to certify FCC Form 463. Complete lines 22 through 25 to certify authorizations to submit the FCC Form 463. Review the attachments and information for accuracy. Once the certifications are complete, select Preview FCC Form 463. Note: You must select Preview the FCC Form 463 in order to move on to the next step of the FCC Form 463. The option to Save and Continue is unavailable unless you havedownloaded and viewed the Excel version of the FCC Form 463. HCF Program Training I Application Process I September 2015 144

FCC Form 463 Step 7: Initiate Certifications HCF Program Training I Application Process I September 2015 145

FCC Form 463 Step 7: Initiate Certifications Download the FCC Form 463 in Excel and preview for accuracy. HCF Program Training I Application Process I September 2015 146

FCC Form 463 Step 7: Initiate Certifications The Excel version of the FCC Form 463 will be displayed in a separate window. HCF Program Training I Application Process I September 2015 147

FCC Form 463 Step 7: Initiate Certifications Once the Excel version of the form has been reviewed for accuracy, select the box for I have reviewed the Form 463 (Excel). If there are no changes, select Save and Continue. HCF Program Training I Application Process I September 2015 148

FCC Form 463 Step 7: Initiate Certifications If changes are necessary, please revisit selections by choosing I have not reviewed the Form 463 (Excel) or I have reviewed the invoice and have changes option. Select Save and Go Back to return to Step 5: Enter Billing Information to repeat the steps necessary to correct the form. HCF Program Training I Application Process I September 2015 149

FCC Form 463 Step 8: Sign and Certify Note: The information in the Signature block is prepopulated based on the account information for the account holder. Click Certify. HCF Program Training I Application Process I September 2015 150

FCC Form 463 Step 8: Sign and Certify Enter the applicant s My Portal password in the Signature field to sign the form. HCF Program Training I Application Process I September 2015 151

FCC Form 463 Step 8: Sign and Certify After the FCC Form 463 has been certified, a prompt will appear to confirm the FCC Form 463 was successfully submitted. HCF Program Training I Application Process I September 2015 152

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Resources Available HCF Program Training I Application Process I September 2015 157

Questions? HCF Program Training I Application Process I September 2015 158

Thank you! Contact Us! Rural Health Care Program (800) 453-1546 RHC-Assist@usac.org HCF Program Training I Application Process I September 2015 159