Assessment Determination Remittance Form
Assessment Determination Remittance Form 0.0015 (0.15%) rate.
Any company certificated or registered by the Missouri Public Service Commission to provide telecommunications service and/or IVoIP service must complete and return this form together with payment to the Missouri Universal Service Fund Administrator except:
Requirement to send Assessment Determination Remittance Form to Administrator
Effective reporting period beginning January 1, 2023
(a) Companies with annual net jurisdictional revenue less than $24,000;
(b) Pay telephone providers; and (c) Shared tenant services (STS) provider.
Information provided will be treated confidentially and will be used only for the operations of the Missouri Universal Service Fund. Please remember that this form is available to submit electronically by clicking on the "Online Form Submission" link from the Quick Links section at the left of the screen.
Payment Frequency for each telecommunications carrier or IVoIP service provider is based on the annual net jurisdictional revenue from the previous calendar year and is determined as follows:
(a) Companies whose annual net jurisdictional revenues fall below $24,000 DO NOT REMIT.
(b) Companies with annual net jurisdictional revenues from $24,000 to $249,999 ~ remit Annually*
(c) Companies with annual net jurisdictional revenues from $250,000 to $999,999 ~ remit Quarterly*
(d) Companies with annual net jurisdictional revenues $1,000,000 and greater ~ remit Monthly
*NOTE: Companies who are to remit annually or quarterly can remit on a more frequent basis, if desired.
This form with payment is due on the 22nd of the month following the reporting period. For example:
(a) Annual report/payment for the reporting period of calendar year 2023 would be due on or before 1/22/24.
(b) Quarterly report/payment for the reporting period of 4/1/23 through 6/30/23 would be due on or before 7/24/23 (Please note…since the 22nd falls on a weekend/holiday, the due date changes to the next business day following the weekend/holiday).
(c) Monthly report/payment for the reporting period of 5/1/23 through 5/31/23 would be due on 6/22/23.
Specific due dates are available by clicking on the "Due Dates" link from the Quick Links area to the left of the screen.
Application for Support Form
Companies approved by the Missouri Universal Service Board to receive support payments from the Fund should use this form to request payment from the fund for discounts applied to Lifeline and Disabled program subscribers. Please remember that this form is available to submit electronically by clicking on the "Online Form Submission" link from the Quick Links area to the left of the screen.
An Application for Support Form should be submitted as soon as practical after the reporting period, but no later than three months.
Electronic Funds Transfer Application
Please use this form should you wish to remit or receive payments electronically.
Lifeline Program Enrollment Form
Disabled Program Enrollment Form
Lifeline Program Household Worksheet