Michigan Public Service Commission

Access Restructuring Mechanism Calculation for Contributing Provider

Reporting Period:   of  

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. 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.

Contact Info

  • Company Name:
  • Contact Name:
  • Phone Number:
  • Email Address:
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 (0.620%):
x
.00620
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 Anne-Marie Clark at 517-373-1594 or clarka@michigan.gov.