September 2002

Important Notice: October 11, 2002 Deadline for Completing FY 2001 Forms 466/468 (9/6/02)

In order to provide support, RHCD must receive a completed Form 466/468 "packet" from rural health care providers who have applied for support for Funding Year 2001 (July 1, 2001 - June 30, 2002). The packet must be postmarked by October 11, 2002. The Form 466/468 packet informs RHCD that the health care provider has entered into an agreement with a telecommunications carrier for a service believed eligible for the universal service support mechanism. The completed Form 466/468 packet must include:

1.) Form 466 (Services Ordered and Certification Form), completed by the health care provider

2.) Form 468 (Telecommunications Service Providers Support Form), completed by the telecommunications carrier representative

3.) Contract document or tariff designation, provided by either the health care provider or telecommunications carrier representative.

4.) If the health care provider is seeking support based on an urban/rural rate comparison, documentation must be included to show the rate for the selected service(s) in the nearest city of 50,000 or more within the state.

If you have questions or require assistance, please contact our Customer Service Support Center at 1-800-229-5476.

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