NXX-X Number Pooling Administrator's Response/Confirmation

Date of Application: __________ Allocation Effective Date: __________

Date of Receipt: __________ Date of Response: __________

Number Pooling Administrator Contact Information:

___________________________ Phone: ________________________

Signature of Pooling Administrator

___________________________ Fax:________________________

Name (print)

• • • • ___ NPA-NXX: _____ Block(s) Assigned: _____ Date of NXX-X Block Assignment: _____

        a. Switch Identification (Switching Entity / POI)11: ________________ Rate Center: __________

        b. Routing and Rating information complete: Yes ______ No ______ Additional RDBS and BRIDS information necessary as follows:

        _____________________________________________________________________

        c. The Pooling Administrator is ____, is not ____responsible for inputting Part 2 information into RDBS and BRIDS.

        d. To be published in the LERG and TPM by _______ additional RDBS and BRIDS information needs to be received by the pooling administrator no later than _______.

        ___ Block Reserved: _______ Date of Reservation: _______

Your block reservation will be honored until _______________

• • Switch Identification (Switching Entity / POI): _____________________
    • • ___ Form incomplete

        Additional information required in the following section(s):

        _____________________________________________________________________

        ___ Form complete, Block request denied.

        Explanation:___________________________________________________________

        _____________________________________________________________________

        ___ Assignment activity suspended by the administrator.

        Explanation:___________________________________________________________

        Further Action: ___________________________________________________________

        ___ NPA in jeopardy: Yes ______ No ______

        Rate Center in jeopardy: Yes ______ No ______

        If yes, refer to Section 11 of the assignment guidelines.

Remarks:

__________________________________________________________________________