Access Restructuring Mechanism Calculation for Contributing Provider
This worksheet must be completed and the resulting confirmation page along with the required
contribution payment must be received by the State of Michigan no later than the 13th of each
month. The reporting period should be the immediately preceding calendar month. All blanks
on this form must be filled in. For
additional information, please see Frequently Asked Questions.
This worksheet will result in a confirmation page that must be printed, signed by an authorized
representative of the company, and submitted along with payment. The authority to collect contributions and set the methodology for doing so is contained throughout Section 310 of the MTA, see specifically Sections (9), (10), and (12). Failure to submit timely payments
to the Access Restructuring Mechanism may be subject to penalties pursuant to Section 310(21) of the
Michigan Telecommunications Act.
Intrastate Retail Telecommunications Services Revenues for reporting month:
Do not use commas. Ex: 5000 NOT 5,000
Less Uncollectible revenues for reporting month:
Do not fill anything in this box
Equals Net Intrastate Retail Telecommunications Services for reporting month:
Times current contribution percentage (0.680%):
Equals Contribution Amount for Payment
When you hit submit below, you will be directed to a confirmation page. As noted above, the confirmation page
should be printed, signed and returned with payment by the 13th of each month. Instructions for remitting payment
are provided on the confirmation page. Questions regarding this form may be addressed to Shannon Withenshaw at 517-284-8203 or firstname.lastname@example.org.