TELECOMMUNICATIONS COMPANY CRITICAL INFORMATION FORM

NEW YORK STATE PUBLIC SERVICE COMMISSION
TELECOMMUNICATIONS COMPANY CRITICAL INFORMATION FORM (TCCI)

What is the TCCI form?
The TCCI form is used to update basic company information in the Department's Telecommunications Company Critical Information Database that is maintained by the Office of Telecommunications. Company information is utilized in a number of Department applications and may be used in emergency situations to quickly correspond with companies.

Who Is Required to File this Form?

ALL telecommunications providers including ALL cable television companies regulated by the New York Public Service Commission are required to complete a TCCI form.
A company that has applied for certification as a telecommunications carrier in New York State.

When should a company Update the Form?

All regulated companies are required to update the form and Stray Voltage Attestation annually December 31 of every year.
A company that has changed its name and filed an Adoption Supplement with the New York Public Service Commission.
A company that has changes to a previously filed TCCI.
A company seeking Commission approval for a merger and/or acquisition, should file once the process has been completed. Note: All companies involved in the merger should complete a new or revised TCCI Form if they will continue to do business in New York.

Instructions:

This form is to be filed electronically, please fill out all fields and press the Submit button when completed. NOTE: If you need a copy of the form for your records, print it before submitting. Do not mail additional copies of the form to the Commission.

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If you have any questions regarding the completion of this form, contact Mary Broderick (518) 486-2832.

This form is being submitted because:

Please check only one of the three following boxes below and follow any applicable instructions for the box chosen.

Annual Update and Stray Voltage Attestation
Please note: Any Active company will be listed as Inactive on the Department of Public Service website if a properly completed Annual TCCI form is not received on a timely basis.

This company is seeking certification in New York State

Company Contact information is being updated as a result of a Merger/Acquistion that has been approved by the Commission or a tarriff Adoption Supplement.If an Adoptions Supplement has been filed, indicate the former company name under "Formerly Known As" below

Form Preparer Information

First Name (required)

Please provide First Name

Last Name (required)

Please provide Last Name

Phone (required)

Please provide Phone Number

e.g. 518-123-4567

Email (required)

Please provide Email Address

Company's Full Registered Name

Select your company (required)

Formerly Known As, if applicable

State in which Certificate of Incorporation was filed (required)

Please provide the name of state

Company Website (required)

Please provide the Company Website

Check if there is no website for the company.

Company Corporate Address

Please provide the Address

Address Line 1 (required)

Address Line 2 (Street Address)

Address Line 3 (Building, Suite, etc.)

City (required)

Please provide the City

State (required)

Please provide the State

Zipcode (required)

Please provide the Zipcode

Attention

Copy Address Information all fields on Form

If Providing Cable Service...

Region where providing service

System

Company President

First Name (required)

Please provide First Name

Last Name (required)

Please provide Last Name

Phone (required)

Please provide Phone Number

e.g. 518-123-4567

Fax

Please provide Fax Number

e.g. 518-123-4567

Email (required)

Please provide Email Address

Mailing Address

Please provide Address

Address Line 1 (Street Address) (required)

Address Line 2 (Building, Suite, etc.)

Address Line 3

City (required)

Please provide the City

State (required)

Please provide the State

Zip Code (required)

Please provide the Zipcode

Attention

Regulatory Contact

First Name (required)

Please provide First Name

Last Name (required)

Please provide Last Name

Title (required)

Please provide the Title

Phone (required)

Please provide the Phone Number

e.g. 518-123-4567

Fax

Please provide the Fax Number

e.g. 518-123-4567

Email (required)

Please provide Email Address

Mailing Address

Please provide Address

Address Line 1 (Street Address) (required)

Address Line 2 (Building, Suite, etc.)

Address Line 3

City (required)

Please provide City

State (required)

Please provide State

Zipcode (required)

Please provide Zipcode

Regulatory Consumer Complaint Contact

First Name (required)

Please provide First Name

Last Name (required)

Please provide Last Name

Phone (required)

Please provide Phone Number

e.g. 518-123-4567

Fax

Please provide Fax Number

e.g. 518-123-4567

Email (required)

Please provide Email Address

Mailing Address

Please provide Address

Address Line 1 (Street Address) (required)

Address Line 2 (Building, Suite, etc.)

Address Line 3

City (required)

Please provide City

State (required)

Please provide State

Zipcode (required)

Please provide Zipcode

Attention

Customer Contact Phone (required)

Please provide Phone Number

e.g. 518-123-4567

Business Office Contact, Representative or Agent

(for billing/assessment purpose)

First Name (required)

Please provide First Name

Last Name (required)

Please provide Last Name

Phone (required)

Please provide Phone Number

e.g. 518-123-4567

Fax

Please provide Fax Number

e.g. 518-123-4567

Email (required)

Please provide Email Address

Mailing Address

Please provide Address

Address Line 1 (Street Address) (required)

Address Line 2 (Building, Suite, etc.)

Address Line 3

City (required)

Please provide City

State (required)

Please provide State

Zipcode (required)

Please provide Zipcode

Attention

Company Officer's Information

First Name (required)

Please provide First Name

Last Name (required)

Please provide Last Name

Title (required)

Please provide the Title

National Electrical Safety Code and National Electrical Code Compliance

By Order issued July 3, 2006 in Case 04-M-0159, the Commission directed all facilities-based telecommunications providers to adhere to appropriate electrical safety codes and attest on an annual basis that they comply with the National Electrical Safety Code and National Electrical Code. Accordingly, by checking the 'yes' box below, I attest that our company's installation, operation, and maintenance practices and procedures are in compliance with applicable National Electrical Safety Code and National Electrical Code.

Yes, our company's practices and procedures are in compliance with applicable National Electrical Safety Code and National Electrical Code.
N/A - Our company is not facilities-based.

Please submit this form by clicking on the SUBMIT button below.
Click Here To Print Completed TCCI Form