Rural Health Care
About Rural Health Care:
- Overview of the Program
- Overview of the Process
- Monthly Conference Calls
- Individual Outreach
- Understanding Audits
- Training Events
- Filing Appeals
- Rural Health Care Pilot Program
Rural Health Care Tools:
Step 5: Submit Service Agreement Form
Once the service provider(s) and services are selected, the HCP completes and submits a Funding Request and Certification Form (FCC Form 466) and/or an Internet Service Funding Request and Certification Form (FCC Form 466-A) with a copy of the bill that indicates the charges for these services.
The FCC Forms 466 and 466-A specify the type(s) of service ordered, cost, name of service provider(s), terms of the service agreements, and certifies that the selections were the most cost-effective offers received.
An HCP may request telecommunications support based strictly on its circuit distance (mileage-based charges) or may request support based on the difference between what it pays and what an equivalent circuit would cost in any city with a population of 50,000 or more in the health care provider's state. HCPs requesting support for Internet access charges will receive support for 25% of the monthly Internet charges, if eligible.
To obtain the information and documents necessary to complete Forms 466 and 466-A, the HCP may need to work with the selected service provider. The service provider may need to provide detailed circuit information, a circuit diagram, a documented urban rate, or contract information.
All certification boxes must be checked on the FCC Forms 466 and 466-A. Paper FCC Forms 466 and 466-A submissions must have a dated original (not photocopied) signature of a person authorized to enter into an agreement for the HCP. E-certification may be used for the FCC Forms 466 and 466-A submitted through the USAC website.
Once the FCC Forms 466 and/or 466-A and all related documentation have been completed, the health care provider should mail all documents to USAC for review. An FCC Form 466 and/or 466-A submitted through e-certification requires supplemental documentation to be sent to USAC by mail. Forms with missing or incomplete information or documentation cannot be processed.
USAC reviews the form(s) and supporting documentation, collectively known as a "packet," for accuracy and completeness, and will contact the HCP if there are any questions about the packet. Health care provider and service provider representatives are strongly encouraged to respond to USAC inquiries in a timely manner to expedite processing of the application as incomplete packets cannot be processed.
