Free FCC Form 492 (pdf version).xls - Federal

FEDERAL COMMUNICATIONS COMMISSION Washington, D.C. 20554 1. Name and Address of Reporting Company

See reverse side for information regarding public burden estimate. 2. Reporting Period (a) Annual Period Covered: From: To:

Approved by OMB 3060-0355

(b) Cumulative Period Covered: From: FCC 492 RATE-OF-RETURN REPORT (Read instructions on the Reverse Before Completing) Dollar Amounts Shown in Thousands (A) Interstate Access (B) Common Line Current Year Cumulative Current Year Cumulative To:

3. Particulars 1. Total Revenues 2. Total Expenses and Taxes 3. Oper. Inc. (Net Return) (1-2) 4. Rate Base - (Avg. Net. Invest.) 5. Rate of Return (3/4) Annualized 6. FCC Ordered Refund Amortized for Current Period (see Line 6 Instr.) 7. Net Return (incl. effect of FCC Ordered Refund) (3+6) 8. Rate of Return (incl. effect of FCC Ordered Refund) (7/4) Annualized 3. Particulars

(C) Special Access Current Year Cumulative

(D) End Office Current Year Cumulative

Switched Traffic Sensitive (E) Information Current Year Cumulative

(F) Local Transport Current Year Cumulative

1. Total Revenues 2. Total Expenses and Taxes 3. Oper. Inc. (Net Return) (1-2) 4. Rate Base - (Avg. Net. Invest.) 5. Rate of Return (3/4) Annualized 6. FCC Ordered Refund Amortized for Current Period (see Line 6 Instr.) 7. Net Return (incl. effect of FCC Ordered Refund) (3+6) 8. Rate of Return (incl. effect of FCC Ordered Refund) (7/4) Annualized 4. Rates of Return for the Switched Traffic Sensitive Category (a) Current Year (b) Cumulative

5. Multiplicative Factor Used for Annualizing Rate of Return for Cumulative Measurement Period 6. Total Out-of-Period Adjustment (see Instruction K)





7. CERTIFICATION: I certify that I am the chief financial officer or the duly assigned accounting officer; that I have examined the foregoing report; that to the best of my knowledge, information, and belief, all statements of fact contained in this report are true and this report is a correct statement of the business and affairs of the above-named respondent in respect to each and every matter set forth therein during the specified period.

Date

Typed Name of Person Signing

Title of Person Signing

Tel. No.

Signature

WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, Section 100D, AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, Section 312(a)(11), AND/OR FORFEITURE (U.S. CODE, TITLE 47, Section 5030.

FCC 492 - September 2004

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FCC 492 General Instructions A. This report is prescribed under authority of Sections 4(i), 4(j) and 205 of the Communications Act of 1934, as amended. FCC 492 shall be filed in triplicate with the Federal Communications Commission, Washington, D.C. 20554, within three (3) months after the end of each calendar year by each local exchange carrier or group of affiliated carriers which is not subject to Sections 61.41 through 61.49 of the Commission's Rules and which has filed individual access tariffs during the enforcement period. One copy is to be filed with the Office of the Secretary, 445 12th Street, S.W., Room TW-B204, Washington, D.C. 20554 and two copies with the Industry Analysis and Technology Division, Wireline Competition Bureau, 6-A162. B. The data shall be aggregated at the same jurisdictional levels as the tariffs. An additional six (6) months from the initial due date, will be allowed for each local exchange carrier or group of affiliated carriers which is not subject to Sections 61.41 through 61.49 of the Commission's Rules to correct their complete enforcement period report. C. All instructions shall be followed. All questions and statements must be completed. If proper answer is "none" or "not applicable," insert that answer. D. Any data that requires clarification should be footnoted and fully explained in the Remarks section below. If the space provided is insufficient for the required data or it is otherwise necessary or desirable to insert additional statements or schedules, the insert pages should include the name of the respondent and the time period covered, in a style of conforming as nearly as practicable to that appearing on the regular page. E. All amounts of money shall be shown in the thousands of dollars. Losses or other negative Items shall be shown in parenthesis. Rates of return shall be shown to the nearest hundredth. F. Revenues should include only revenues earned during the report period. Costs should also reflect only those costs incurred in the report period. G. Interstate adjustments to rate base, expenses and revenues shall be based upon FCC Docket 19129 and other relevant Commission orders, if applicable to the reporting entity. Specific Instructions (referenced to item numbers on form) H. Item 3. Particulars Column A - Interstate Access. The dollar amounts in column A should equal the sum of the dollar amounts in columns B through F for both the current year and cumulative periods. Likewise, the rates of return in column A shall equal the weighted average of the rates of return in columns B through F. Line 1 - Total Revenues ­ (earned during the report period) shall include service revenues, interest during construction, if applicable, and miscellaneous operating revenues less uncollectibles. Line 2 ­ Total Expenses and Taxes ­ shall include operating expenses, depreciation, amortization, other expenses, interstate allowances and disallowances if applicable, as well as all taxes. Line 4 ­ Rate Base (Average Net Investment) shall include accounts 2001, 2002, 2003, 2005, 1410, 1438, Cash and Working Capital as developed pursuant to CC Docket 86-497, less accounts 3100, 3200, 3410, 4100, 4300, and 4340. It shall also include interstate rate base allowances and disallowances, if applicable. The method for calculating Rate Base (Average Net Investment) shall be in accordance with the ARMIS Order, CC Docket 86-182, released July 20, 1990. Line 6 ­ Use the following table to calculate the after tax effect on an FCC ordered refund: 1. FCC Ordered Refund Total _______________________ 2. Refund for Period (Amortized) ____________________ 3. Tax Rate ______________________________________ 4. Refund Adjusted for Taxes _______________________ (Line 2 times (1 minus Line 3)) (Enter this amount) I. Item 4 ­ Rates of Return for the Switched Traffic Sensitive Category should be calculated and entered in item 4 on the form. Switched traffic sensitive consists of line termination, local switching, intercept, information and local transport. End office includes line termination, local switching and intercept. For reporting purposes, equal access implementation costs should be included within "end office." J. Item 5 ­ Multiplicative Factor for Cumulative Measurement ­ rates of return for the cumulative measurement period shall be annualized with the appropriate multiplicative factor and shown in item 5. K. Item 6 ­ Total Out-of-Period Adjustment. Report total out-of-period adjustments for the cumulative period in item 6. Significant out-of-period adjustments should be footnoted and explained in the Remarks section below. Significant out-of-period adjustments are those adjustments having an annualized 10 basis points or more impact within the three enforcement categories (common line, special access, switched traffic sensitive). In connection with the 10 basis point threshold, carriers need only report retroactive adjustments above the following amounts: $1,000,000 for common line revenues; $300,000 for special access revenues; and $300,000 for switched traffic sensitive categories. Out-of-period adjustments from prior enforcement periods identified more than nine months after the prior enforcement periods have ended should be shown separately in the Remarks section if (1) a company's rate of return for an enforcement category was within 10 basis points of a refund situation and (2) will cause the prior rate of return to go above its allowed maximum. In each case, the appropriate enforcement periods should be clearly indicated. Notice to Individuals ­ FCC 492 is needed to provide this Commission with data required to fulfill its regulatory responsibilities with respect to interstate telephone service under Title II of the Communications Act of 1934, as amended. FCC 492 is necessary to enable the Commission to monitor access tariffs and to enforce rate-of-return prescriptions. Your response is mandatory. Remember ­ You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid Office of Management and Budget (OMB) control number. This collection has been assigned an OMB control number of 3060-0355. We have estimated that each response to this collection of information will take, on average, 8 hours. Our estimate includes the time to read the instructions, look through existing records, gather and maintain the required data, and actually complete and review the form or response. If you have any comments on this estimate, or how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, AMD-PERM, Washington, D.C. 20554, Paperwork Reduction Project (3060-0355). We will also accept your comments via the Internet if you send them to [email protected]. Please DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. The foregoing Notice is required by the Privacy Act of 1974, P.L. 93-579, December 31, 1974, 5 U.S.C. 552(a)(e)(3), and the Paperwork Reduction Act of 1995, P.L. 104-13, 44 U.S.C. 3507. ____________________________________________________________________________________________________________________________ Remarks:

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