Letter of Agency
If you are a health care provider (HCP) that is not owned or controlled by the consortium leader, you need to file a letter of agency (LOA). The LOA authorizes the consortium leader to file forms and act on your behalf in matters related to the HCF Program. The LOA is written by the participating HCP and is addressed to the consortium leader (also called “lead entity”).
You must submit LOAs to USAC using My Portal. To review the step-by-step process, review the LOA/LOE Submission Guide.
Download a Sample LOA.
The LOA must include the following:
- Name of the entity filing the application (i.e. lead entity or consortium leader);
- Name of HCP/consortium member authorizing the lead entity to file the application on its behalf;
- Physical location or address of the HCP/consortium member site(s);
- Specific timeframe the LOA covers (i.e., the start date and end date);
- Signature, title, and contact information (including mailing address, phone number, and email address) of an official authorized to act on behalf of the HCP/consortium member;
- For HCPs on Tribal lands:If the health care facility is a contract facility run solely by a Tribal nation, the appropriate Tribal leader, such as a Tribal chairperson, president, governor, or chief, must also sign the LOA, unless health care responsibilities have been delegated to another Tribal government representative.
- Date of signature;
- Type of services covered by the LOA; and
- Relationship of each HCP seeking support to the lead entity filing the application on their behalf.
USAC recommends that the LOA:
- Be submitted on the letterhead of the participating health system or consortium member.
- Include a statement authorizing the consortium leader to submit the FCC Form 460 (Eligibility and Registration Form), submit the FCC Form 461 (Request for Services Form), prepare and post the request for proposal (RFP), submit the FCC Form 462 (Funding Request Form), and manage invoicing and payments on behalf of the consortium member.
- Include the HCP number(s) with the physical location or address of the HCP/consortium member site(s);
- Include the following suggested language to ensure compliance with the third party authorization (TPA) requirement for consortium members using third parties to file forms on their behalf:
- “[HCP Name] hereby authorizes [Consortium Leader Name] and its agents to act on its behalf…”
- “[HCP Name] authorizes [Consortium Leader Name] and its agents to: [HCP Name] authorizes [Consortium Leader Name] and its agents to submit the FCC Form 461…”
- “By this Letter of Agency, [HCP Name] authorizes [Consortium Leader Name] and its agents to make the certifications included in the FCC Form 461…”
The material on these web pages is provided for general information only and should not be relied upon or used as the sole basis for making decisions without consulting the RHC Program rules, orders, and other primary sources of information. Applicants and service providers are ultimately responsible for knowing and complying with all RHC Program rules and procedures.