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Invoice #                                Check #                                 
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THE STATE OF
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Public Service Commission
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HANSEN BUILDING, SUITE 300 2515 WARREN AVENUE CHEYENNE, WYOMING 82002
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Phone: (307) 777-7427 Fax: (307) 777-5700 Website: psc.wyo.gov Email: wusf@wyo.gov
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Revenue & Assessment True-up Form
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Company Name:Instructions: Once you have completed the WUSF True-Up form, please save it as a PDF document and send it to the WUSF along with any payment and late fee amount due. Please do not alter the spreadsheet.
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Docket Management System #:
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January 1, 2024 to December 31, 2024
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If no changes are necessary to the originally reported gross intrastate retail revenue, it is not necessary to complete and return this form.
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A.
Reporting Period 2024		B.
Reported Revenue		C.
Actual Revenue		D.
Revenue Over/(Under)
Reported
(B - C)		E.
Assessment Rate		F.
Assessment Over/(Under) Paid (D x E)
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January $ - 2.30 % $ -
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February $ - 2.30 % $ -
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March (1Q) $ - 2.30 % $ -
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April $ - 2.30 % $ -
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May $ - 2.30 % $ -
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June (2Q) $ - 2.30 % $ -
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July $ - 1.90 % $ -
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August $ - 1.90 % $ -
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September (3Q) $ - 1.90 % $ -
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October $ - 1.90 % $ -
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November $ - 1.90 % $ -
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December (4Q) $ - 1.90 % $ -
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TOTAL $ - $ - $ - $ -
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1. CREDIT/(PAYMENT) to Wyoming Universal Service Fund
(Total amount from column F)		 $ -
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2. CREDIT. If line 1 is a positive amount, this amount is the WUSF assessment you have overpaid. Claim this amount as a credit on line 17 of future WUSF revenue and assessment forms. $ -
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3. PAYMENT. If line 1 is a negative number, this amount is the WUSF assessment you have underpaid. $ -
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4.) DATE. Input the Date the late payment is being sent to the WUSF for the late fee amount due to be automatically calculated.
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5.) LATE PAYMENT CHARGE. If the company underpaid, please calculate and submit a late payment charge equal to one and one-half percent (1.5%) on the unpaid amount for each month, or part thereof, that the assessment remains unpaid. $ -
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6.) TOTAL AMOUNT DUE. Total of line 3 and 4, if applicable. Please send payment along with this form to the WUSF.
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Please complete this form, if changes are necessary, to the reported retail revenue for the period of January 1, 2024 to December 31, 2024. Include the originally reported gross intrastate retail revenue amount in column B and corrected gross intrastate retail revenue amount in column C. Make the appropriate calculations in columns D and F as needed. Please send completed forms to the Wyoming Universal Service Fund by March 1, 2025. Questions should be directed to the WUSF Analyst at (307) 777-5701 or by email at wusf@wyo.gov.
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Oath: Under penalty of perjury, I declare that I have examined this report, and that it is true, correct and complete to the best of my knowledge, information, and belief.
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Signature:
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Print Name:
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Title:
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Phone:
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Email:
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Check here if paying by EFT. EFT Payment Date:To pay by EFT: Use routing # 121000248 and account # 4941332611 Payable to: WUSF/PSC/State of Wyoming. Please submit this form via email to wusf@wyo.gov.
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Check here if paid by check. Check #Make checks payable to: WUSF, 2515 Warren Avenue, Suite 300, Cheyenne, WY 82002 Please enclose this form with your mailed check.
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