MO Universal Service Fund

Assessment Determination Remittance Form

    Assessment Determination Remittance Form 0.0010 (0.10%) rate with new frequency- New form includes information on the new annual frequency. Please destroy all older forms you may have.

    Missouri certificated/registered telecommunications carriers and interconnected voice over Internet protocol service providers (VoIP) must complete and return this form together with payment to the Missouri Universal Service Fund Administrator. 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.

    All telecommunications companies certificated to provide telecommunications services and all registered interconnected voice over Internet protocol service providers in Missouri are required to submit this form and remit payment to the Missouri Universal Service Fund except:
      (a) pay telephone providers;
      (b) shared tenant services (STS) providers; and
      (c) companies with annual net jurisdictional revenue below a de minimis level of twenty-four thousand dollars ($24,000).

    Payment Frequency for each telecommunications carrier or VoIP 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. Companies falling in this category still need to file the Annual Net Jurisdictional Revenue Report (in addition to, and separate from the annual report due the Missouri Public Service Commission).
      (b) Companies with annual net jurisdictional revenues from $24,000 to $249,999 ~ remit Annually (or may remain as quarterly)
      (c) Companies with annual net jurisdictional revenues from $250,000 to $999,999 ~ remit Quarterly (or may remain as monthly)
      (d) Companies with annual net jurisdictional revenues $1,000,000 and greater ~ remit Monthly

Application for Support
    Telecommunications 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 low income or disabled 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.

    For Support requests up to and including the reporting period of September 2014, please click here to get form.
    For Support requests from October 2014 and going forward, please click here to get form.

EFT Application
    Please use this form should you wish to remit or receive payments electronically.

Net Jurisdictional Revenue Report
    Certificated/registered Telecommunications companies and interconnected voice over Internet protocol service providers (VoIP) are required to submit this form annually to report revenues for the previous calendar year. The annual report for the 2016 calendar year is now available and may be submitted electronically by clicking on the "Online Form Submission" link from the Quick Links area to the left of the screen. By clicking the form name above, you can obtain a paper copy of this report should you choose to submit this form by paper.

Application for Low Income or Disabled discounts through the Missouri Universal Service Fund

Board approved Applications for Support can be obtained by clicking on the appropriate link below:

Missouri Application for the Lifeline or Disabled Program
Missouri Application for the Lifeline Program
Lifeline FSD Program Verification Samples
Lifeline Household Worksheet

Please complete the appropriate form and give to your local telephone company.