ELAPtemplateforParticipants 3060-1149 final

OMB 3060-1149

High Cost Universal Service

Information to be Submitted to Online Eligible Locations Adjustment Process (ELAP) Portal

(Note: This is a representative description of the information to be collected via the online portal and is not intended to be a visual representation of what each applicant will see).

Participant Information

Item Number	Field Description	Purpose/Instructions
1	Participant Name	This is the name of the authorized support recipient participating in this process. May be autogenerated by system.
2	Participant Address	This is the physical and mailing address of the participating support recipient to be used for service and notice purposes.
2	Data Contact Name(s)	Name(s) of the person(s) who prepared the submitted data
3	Data Contact Phone Number(s)	Phone number(s) of Data Contact Name(s)
4	Data Contact Phone Number(s) extension	Phone number extension, if any, of Data Contact Name(s)
5	Data Contact E-mail address(es)	Email address(es) of Data Contact Name(s)
6	Study Area Code(s)	Study Area code(s) applicable to data filed.
7	State	The state or states for which the carrier is making a filing.
8	Location ID	A number that uniquely identifies a reported location in the study area. Automatically generated by the system.
9	Census Block Code	The census block code of the location. Autogenerated by system based on submitted latitude/longitude of location.
10	Latitude of Location	Latitude of the reported location.
11	Longitude of Location	Longitude of reported location.
12	Location Address – Number & Street	Number and street address of the location.
13	Location Address-City	City associated with the street address of the location
14	Location Address-State	2 letter postal code abbreviation of the state associated with the street address of the location.
15	Location Address-Zip Code	5-digit ZIP code associated with the street address of the location
16	Location Address-No Postal Address Available	In those cases where postal address is not available, alternate address information
17	Number of units	If the location is a building with multiple units, such as an apartment or office building, the number units at that location.
18	GPS Method	Identifies primary method (i.e., field research, computer-based geolocation, or automated address geolocation) used to geolocate reported location
19	GPS Method as of Date	Date that field research or underlying research for computer-based or automated address geolocation was last confirmed as accurate
20	Location Type	Identifies reported location as qualifying location, prospective location, ineligible location.
21	Ineligible Reason Code	Identifies reason why specified location is marked ineligible, using preset drop- down list.
22	Ineligible Reason Comment	Further explanation if participant selects “other” as reason code for marking location as ineligible.
24	Methodology for Identifying Eligible Locations	Narrative description (pdf) of methodology or methodologies used to identify all eligible locations within the state
25	Supporting Evidence	Evidence supporting description of methodology and identification of locations, e.g., copies of (or links to) web-based photography, database pages, and/or public records information for a sample of randomly selected land units (e.g., parcels, plots).
23	Officer Certification	Officer certification that ELAP information is complete and accurate to the best of the officer’s knowledge and belief
24	Certifying Official Name	Name of certifying official.
25	Certifying Official Title	Job title of certifying official
26	Certifying Official Phone Number	Phone number of the certifying official
27	Certifying Official Phone Number, Extension	Phone number extension of the certifying official
28	Certifying Official Email Address	Email address of the certifying official
29	Date Signed	The date on which the filing is certified. Auto-generated

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