BIENNIAL AUDIT PLAN, UNIVERSAL SERVICE FUND – LIFELINE PROGRAM, APPENDIX A, TABLE 2
Last Name First Name
Physical/
Service 
Address
Apt, Unit, 
or Lot # City State Zip
Telephon
e Number
Line provided to 
wireline reseller?
[Y/N]
(Form 555 
Column B)
Subscriber 
contacted directly 
to re-certify 
eligibility?
[Y/N]
(Form 555 
Column C)
Subscriber 
responded to 
direct contact to 
re-certify 
eligibility?
[Y/N/NA]
(Form 555 
Column D)
Subscriber 
responded to 
direct contact that 
he/she is no 
longer eligible?
[Y/N/NA]
(Form 555 
Column F)
Subscriber de-
enrolled prior to 
direct contact to 
re-certify 
eligibility?
[Y/N/NA]
(Form 555 
Column H)
Subscriber 
eligibility reviewed 
by state 
administrator or 
via access to 
eligibility data?
[Y/N]
(Form 555 
Column I)
Subscriber found 
ineligible through 
review by state 
administrator or 
via access to 
eligibility data?
[Y/N/NA]
(Form 555 
Column J)
Subscriber de-
enrolled prior to 
state 
administrator re-
certification 
attempt or 
eligibility data 
review?
[Y/N/NA]
(Form 555 
Column L)
Direct Contact Re-certification State Administrator/Eligibility Data Re-certification