Fillable FCC Form 497 Address change edits October 2009 - usac
FCC Form 497
July 2008 Edition
LIFELINE AND LINK UP WORKSHEET
Approved by OMB 3060-0819 Avg. Burden Est. per Respondent: 3.0 Hrs.
USAC Service Provider Identification Number (1) (3) Company Name: Mailing Address: (4)
a) Submission Date b) Data Month
Serving Area (2)
Contact Name: Telephone Number: Fax Number: E-mail Address:
c) Type of filing (Check one): d) State Reporting
Fill & Sign Online, Print, Email, Fax, or Download
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