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Z2 " This collection of information stems from the Commission's authority under Section 254 of the Communications Act of 1934, as  Z2" amend, 47 U.S.C. Section 254. The information will be used by the Commission and the Administrator to determine which carriers  Z25$ qualify for the international revenues exception that is being adopted in response to the the July 30, 1999 mandate of the United States  {Oq' Z2e# Court of Appeals for the Fifth Circuit in Texas Office of Public Utility Counsel v. FCC, 183 F.3d 393 (5th Cir. 1999). The information  Z2# requested in the Amendment worksheets is not otherwise available. Without such information the Commission could not determine  Z2j! contributions to the support mechanisms and, therefore, could not fulfill its statutory responsibilities in accordance with the Communications Act of 1934, as amended.  Z2# We have estimated that each response to this collection of information will take, on average, 2 hours. Our estimate includes the time  Z21# to read the instructions, look through existing records, gather and maintain the required data, and actually complete and review the  Z2# form or response. If you have any comments on this estimate, or how we can improve the collection and reduce the burden it causes  Z2" you, please write the Federal Communications Commission, AMDPERM, Washington, D.C. 20554, Paperwork Reduction Project  Z2! (30600907). We will also accept your comments via the Internet if you send them to jboley@fcc.gov. Please DO NOT SEND COMPLETED WORKSHEETS TO THIS ADDRESS.  yO' Z2' Remember You are not required to respond to a collection of information sponsored by the Federal government, and the  Z2y(government may not conduct or sponsor this collection, unless it displays a currently valid Office of Management and Budget (OMB) control number. This collection has been assigned an OMB control number of 30600907.  yO+'  Z2" The Commission is authorized under the Communications Act of 1934, as amended, to collect the personal information we request  Z2w! in this form. We will use the information that you provide to determine contributions amounts. If we believe there may be a  Z2# violation or potential violation of a statute or a Commission regulation, rule or order, your Worksheet may be referred to the Federal,  Z2# state, or local agency responsible for investigating, prosecuting, enforcing, or implementing the statute, rule, regulation, or order. In  Z25$ certain cases, the information in our Worksheet may be disclosed to the Department of Justice, court, or other adjudicative body when  Z2$# (a) the Commission; or (b) any employee of the Commission; or (c) the United States government, is a party to a proceeding before the body or has an interest in the proceeding.  Z2r# If you owe a past due debt to the Federal government, the taxpayer identification number (such as your social security number) and  Z2" other information you provide may be disclosed to the Department of the Treasury Financial Management Service, other federal  Z2" agencies, and or your employer to offset your salary, IRS tax refund, or other payments to collect that debt. The Commission also may provide this information to those agencies through the matching of computer records where authorized.  Z2$ With the exception of your social security number, if you do not provide the information we request on the Worksheet, the Commission may consider you in violation of sections 1.47, 54.713 of the Commissions rules. 47 C.F.R. Sections 1.47, 54.713.  Z2a" The foregoing Notice is required by the Privacy Act of 1974, Pl. 93579, December 31, 1974, 5 U.S.C. Section 552(a)(e)(3), and the  yO;('Paperwork Reduction Act of 1995, P.L. No. 10413, 44 U.S.C. Section 3501, et seq. #XP\  P6QynXP#";(0*0*0*'"  X4 XX  XXXX J AMENDMENT ă  X4 To September 1999 Telecommunications Reporting Worksheet (FCC Form 499S) ă  yO'#X\  P6G;ɒP#  yO'Contributor Identification` ` X MXXhhXXW XppXX   Where to File this Amendment ƀ%   yOb'#X\  P6G;ɒP#Legal Name of Contributor: ____________________hXWXppXX   USAC FCC Form 499Sƀ%   yO*'Name Contributor is Doing Business as: ____________________WXppXX   Interstate/International Amendmentƀ%   yO'IRS Employer Identification Number: ____________________WXppXX   100 South Jefferson Roadƀ%   yO'Filer 499 ID (formerly TRS Company Code): ____________________ppXX   Whippany, NJ 07981ƀ%   yOJ'Contact Information Name of Person Who Completed this Amendment: ____________________ Telephone Number of Person Who Completed this Amendment: ____________________ Complete Mailing Address of Person Who Completed this Amendment: ____________________ ____________________ ____________________  yO 'Revenue Information (Revenue data must be reported in whole dollar amounts) #Xj\  P6G;ynXP# c ddx !XRP  c    ""  Amount from Line 115, Column C, of September 1999R  aE#G\  P6G;مP#(a)#Xj\  P6G;ynXP#R Percent InterstateR  aE#G\  P6G;مP#(b)#Xj\  P6G;ynXP#R Amount InterstateR  aE#G\  P6G;مP#(d)#Xj\  P6G;ynXP#  R ""  Telecommunications Reporting Worksheet (FCC Form 499S)B  B Percent International R  aE#G\  P6G;مP#(c)#Xj\  P6G;ynXP#R Amount InternationalR  aE#G\  P6G;مP#(e)#Xj\  P6G;ynXP#" 0  R" "" #d i# fi#i  aE#G\  P6G;مP#Box (b) +#G\  P6G;مP# Box (c) must equal 100%  0  R yO'#X\  P6G;ɒP#Instructions for Revenue Information  yOJ'  , Box (a):Enter the Amount from Line 115, Column C, of your September 1999 Telecommunications Reporting Worksheet   ,* (FCC Form 499S). If you did not retain a copy of your September 1999 Worksheet, please contact the Universal Service Administrative Company to obtain a copy of that document. (973) 5604400.ƀ%  yOj'  , Box (b):Enter the percentage of revenues from Box (a) that are interstate. Interstate telecommunications means   ,b telecommunications between a point in one state, territory, or possession of the United States and a point in another state, territory, or possession of the United States.ƀ%  yO'  ,g Box (c):Enter the percentage of revenues from Box (a) that are international. International telecommunications means   , telecommunications between a point in one state, territory, or possession of the United States and a point outside any state, territory, or possession of the United States.ƀ%  yO'XX NOTE: Box (b) + Box (c) must equal 100%. ƀ%  yO: 'Box (d):Multiply Box (a) times Box (b) and enter the result in Box (d).ƀ%  yO!'Box (e):Multiply Box (a) times Box (c) and enter the result in Box (e).ƀ%  yOZ#'Certification (To be signed by an officer of the contributor)  Z2a" I hereby certify that I am an officer of the abovenamed contributor, that I have examined this Amendment and to the best of my  Z2O$ knowledge, information and belief, all statements of fact contained in this Amendment are true and that said Amendment is an accurate statement of the affairs of the abovenamed contributor.  yOB''Signature: ____________________ XhhXPrinted Name of Officer: ____________________ƀ%  yO ('Position With Contributor: ____________________hhXDate: ____________________ƀ%  yO)'Request for Commission nondisclosure of information contained in the Amendment  Z2"  Certification that information contained in this Amendment is privileged or confidential commercial or financial information and  Z25$ that disclosure of such information would likely cause substantial harm to the competitive position of the entity filing the Amendment. This box may be checked in lieu of submitting a separate request pursuant to  0.459 of the Commission's rules.  - y(#X/dddy  aE-#G\  P6G;مP#Persons making willful false statements in this Amendment can be punished by fine or imprisonment under Title 18 of the United States Code, 18 U.S.C.  1001. Approved by OMB, 30600907. Estimated average burden hours per response: 2 hours.`N%kFCC Form 499S (M), 10/99