Purpose of Form 466

Please read this page before completing Form 466.

Note: Form 465 must be approved by the RHCD and posted for 28 days before Form 466 can be summitted. Exceptions to the posting requirement are constracts in place prior to 7/10/97.

The Services Ordered and Certification Form (Form 466) is how a health care provider (HCP) informs the RHCD that it has entered into an agreement (contract or tariff) with an eligible telecommunications carrier for services supported by the Universal Service Support Fund.

An HCP must complete a Form 466 for each telecommunications carrier with whom it has signed a contract or purchased a service at tariffed rates for supported telecommunication services.

Form 466 must be submitted with the Telecommunications Service Providers Support Form (Form 468), completed by the telecommunications carrier(s) with whom the HCP has signed a contract for service or purchased service at tariffed rates.

The RHCD will not process Form 466 without an accompanying Form 468 and a copy of the service contract or tariff number/agreement.

If you would like to print a copy of Form 466, you can view or download the file.

To complete Form 466 on-line, go to HCP Forms on the Web.

We recommend that you print out "EZ" Step-by-Step Instructions to follow while completing Form 466.

If you would like a copy of Form 466 mailed to you, please contact our Customer Service Support Center.