CLEC VoIP (Interconnected) Radio Common Carrier (wireless)
1. Total number of access lines and wireless instruments billed and unbilled during report period
2. Subtractions/Exemptions
a. Unpaid access line and wireless instrument billings
b. Number of lines paid by others due to interconnection agreements
c. Exempt entities:
i. Counties or political subdivisions
ii. Federal, state, and municipal government bodies or public corporations (including
regional housing authorities)
iii. Federally chartered corporations specifically exempt from state excise taxes by federal law
iv. Federally recognized Native American Tribes and tribal members who live within federally
recognized Native American territory and are enrolled members of the tribe with
sovereignty over that Native American territory
v. Foreign government offices and representatives that are exempt from state taxation
by treaty provisions
d. Unbilled access lines
e. Other
Total Subtractions/Exemptions (Lines 2a - 2e)
0
3. Total number of access lines/wireless instruments subject to surcharge (Line 1 - Total Subtractions/Exemptions)
0
4. Current surcharge per access line/wireless instrument
0.10$
5. Total surcharge amount due (Line 3 X Line 4)
$
TOTAL AMOUNT DUE
Mail report and payment to:
Public Utility Commission
Amended Return
Residential Service Protection Fund Mailing Address Change
PO Box 2153, Salem, OR 97308-2153 Final Report
Please refer to FORM 751 Guidelines for help in filling out this form.
If you have questions contact Frank Lackey, RSPF Compliance Specialist, (503) 378-4927
frank.lackey@state.or.us FORM 751 (5/2020)
https://rspf.puc.state.or.us
OR report/remit online at:
Month/Year:
OREGON PUBLIC UTILITY COMMISSION RESIDENTIAL SERVICE PROTECTION FUND (RSPF)
RSPF SURCHARGE REMITTANCE FORM
Telecommunications Provider's Name and Business Office Address
SERVICE PROVIDER:
Telecommunications providers must collect & remit the RSPF surcharge on all customer lines with access to OR Telecommunications Relay Service (OTRS).
ILEC
PROVIDER Contact Name:
(responsible for verification of submitted info)
PROVIDER Address:
PUC Assigned Company ID#:
Telephone:
City: State: ZIP: Email:
City: State: ZIP:
PREPARER Name & Company Name:
Telephone: PREPARER Address:
Email:
I certify this report is true and correct and complies with ORS 759.680
Public Utility Commission
CHECK CORRESPONDING BOX FOR:
The RSPF surcharge remittance form and payment are due on or before the 21st calendar day following the reporting month.
Signature Required - Print & Sign
Late reports and payments are subject to late reporting fees, penalties and interest pursuant to OAR 860-001-0050.
