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Item 21 Attachments for E-rate Form 471, Block 5

Each Form 471 Block 5 funding request must include a separate description of the products and services for which discounts are being sought. This description is known as an "Item 21 Attachment." Several different formats are possible for the Item 21 Attachment. However, the Item 21 Attachment generally consists of these parts:

  • Narrative overview or description

  • Line item detail of the products and services requested

  • Any additional details, if needed, such as equipment locations or other information to support the funding request

(USAC/SLD Reference Area: Item 21 Attachments For Form 471)

The Item 21 Attachment provides details on the products or services requested in an FRN and who will receive them. It can be filed online, by fax or on paper. (USAC/SLD Web Site: Acronyms and Terms List)

USAC/SLD PowerPoints and Documents:

Sample Item 21 Attachments from the USAC/SLD Web Site in PDF:

Additional Related References:

Additional Updates:

Examples of Required Certifications (Item 21 Attachments for Form 471):

Network File Servers: The network file server(s) for which I seek discounts will be used only for the following eligible purposes: [applicants should indicate the eligible uses for the server(s)]. The server(s) will not be used for ineligible purposes, including but not limited to the following ineligible uses: Application Server (e.g., providing application software to end users), Database Server, Data Warehouse Server (including storage of non-e-mail end user files), and Archive Server.

Extensive File Storage: The storage capacity for which I seek discounts will be used only for the following eligible purposes: [applicants should indicate the eligible uses of the storage]. The storage will not be used for ineligible purposes, including but not limited to the following ineligible uses: storage of end user files other than e-mail, storage for application software or other ineligible software, storage of archival information, and storage for caching.

Wireless Components: The wireless components for which I seek discounts will not be configured to enable data or other communication across a public right of way, and will be used only for connectivity within a single campus of a school or library facility.

Remote Access Certification: The remote access equipment for which I seek discounts either will not be used to provide remote access or, if it is to be used remotely, I will take steps to ensure that only entities eligible for support under the Schools and Libraries Support Mechanism have the capability to access it. In the latter case, for example, access will not be available from homes or other non-school or non-library sites.

Virtual Private Networks (VPNs): The data distribution equipment for which I seek discounts will not be used for ineligible purposes, such as establishing a Virtual Private Network. Any such functionality available in E-rate funded components will not be utilized.