Rural Health Care

Step 2: Service Request (Form 465)

All health care providers must complete the Description of Services Requested and Certification Form (Form 465). Form 465 is how health care providers request bids for eligible services.

Participants indicate on a single Form 465 whether they are applying for support for telecommunications service, Internet access discounts, or both. Form 465 is the health care provider's certification that it meets program eligibility requirements.

Each health care provider is assigned a Health Care Provider (HCP) Number. The five-digit HCP Number is used by USAC to track applications and is a required field on all forms used in the application process. The HCP Number is consistent across multiple funding years. If a health care provider has applied for support in previous funding years, it should not request a new HCP number.

If a health care provider does not have an HCP Number, it must complete Form 465 (see required forms under Rural Health Care Tools) and mail it to the address on the form. Next USAC determines eligibility. If the health care provider is eligible, an HCP Number will be issued and the Form 465 is posted to the USAC website. A user-changeable password is issued with the HCP Number for use on the USAC website to complete forms or review specific information.

USAC recognizes that many health care providers belong to groups or consortia that share resources and negotiate with service providers. A separate Form 465 must be completed for each health care provider at a different physical location within the consortia that is eligible to receive support.

New participants must complete, print, sign, and mail a paper Form 465 to USAC. After the initial paper Form 465 is approved, participants may use the electronic application, also called E-certification. E-certification allows participants to electronically sign and immediately post Form 465s on the USAC website after review?. To expedite the review process, participants with Internet access are encouraged to log in and complete Form 465 online. All participants that have successfully posted a Form 465 may enable E-certification.

Paper submissions of Form 465 must be signed and mailed to USAC for review and posting at:

Universal Service Administrative Company
Rural Health Care Program
80 S. Jefferson Road
Whippany, NJ 07981

First-time participants will receive a letter notifying them of their HCP Number and password if they are determined to be eligible. Paper filers will receive a letter confirming the posting and will be given the allowable carrier selection date, which is 28 days after the posting date. This is the first day a health care provider may sign an agreement with a service provider. Participants that use E-certification for Form 465 will receive the confirmation letter by e-mail.


Last modified on 1/6/2006