Note: The health care provider's Form 465 must by approved by the RHCD before Form 468 can be submitted.

After signing a contract for services, the HCP and telecommunications carrier must submit information about their contract to the RHCD. Health care providers must complete Form 466. This form informs the RHCD of the details of the contract, including which telecommunications services the health care provider ordered.

At the same time, the telecommunications carrier must complete a form entitled Telecommunications Service Providers Support Form (Form 468). This form notifies the RHCD of the rates for which the telecommunications carrier and health care provider have contracted. It also requires the telecommunications carrier to certify that it is eligible to receive universal service support. The RHCD will not process Form 468 without Form 466 and a copy of the service contract and tariff number/agreement.

If you would like to print a copy of Form 468, you can view or download the file.

To complete Form 468 on-line, go to Telco Forms on the Web.

We recommend that you print out "EZ" Step-by-Step Instructions to follow while completing Form 468.

If you would like a copy of Form 468 mailed to you, please contact our Customer Service Support Center.