Utility Forms
Forms For All Utilities
- New Facility Locate Agreement FAQ: PDF format
- New Facility Locate Agreement Form: PDF format
- Non-Payment Disconnection/Reconnection Report
- New Meeting Request Form: (Word format)
- Adoption Notice: (PDF format), (Word format)
-
- ARF Form 1 – Alternative Rate Filing Application
- ARF Form 3 – Statement of Disclosure
- ARF Form 1 - Attachment I - Instructions
- ARF Form 1 - Attachment SR - Reasons for Application
- ARF Form 1 - Attachment CPR - Current and Proposed Rates
- ARF Form 1 - Attachment SAO-G - Schedule of Adjusted Operations - Gas Utility
- ARF Form 1 - Attachment SAO-S - Schedule of Adjusted Operations - Sewer Utility
- ARF Form 1 - Attachment SAO-W - Schedule of Adjusted Operations - Water Utility
- ARF Form 1 – Attachment OME-1 - Sewer Operations and Maintenance Expenses
- ARF Form 1 - Attachment RR-DC - Revenue Requirement Calculation Form - Debt Coverage
- ARF Form 1 - Attachment RR-OR - Revenue Requirement Calculation Form - Operating Ratio Method
- ARF Form 1 - Attachment BA-DB - Billing Analysis Form - Declining Block Rates Instructions
- ARF Form 1 - Attachment BA-FR - Billing Analysis Form - Flat Rates
-
- Pursuant to 807 KAR 5:006, Section 4(2), for reporting years 2012 and forward, every utility shall file annually using the commission’s electronic filing system a financial and statistical report on or before March 31 of each year. Should you have any questions, please email [email protected]
-
-
Note:
The Filing Requirements Check Lists have now been updated to reflect the revisions to the Public Service Commission’s administrative regulation that occurred in October 2013 and January 2014.
- Alternative Rate Filing (ARF): (PDF File), (Word File)
- Authority to Adjust Rates - Sewage Utility (Historical Test Period): (PDF File), (Word File)
- Decrease in Revenue of an Electric Cooperative: (PDF File), (Word File)
- Certificate of Public Convenience and Necessity - Construction: (PDF File), (Word File)
- Certificate of Public Convenience and Necessity - Construction - Incumbent Local Exchange Carriers: (PDF File), (Word File)
- Certificate of Public Convenience and Necessity - Construction - Sewers Only: (PDF File), (Word File)
- Certificate of Public Convenience and Necessity - Construction - To Construct Antenna Towers for Cellular Telecommunications Services or Personal Communication Services in Jurisdictions Without a Planning Commission: (PDF File), (Word File)
- Certificate of Public Convenience and Necessity - Federally Funded Construction Projects: (PDF File), (Word File)
- Certificate of Public Convenience and Necessity - Initial Operations With Tariff: (PDF File), (Word File)
- Certificate of Public Convenience and Necessity - Initial Operations Without Tariff: (PDF File), (Word File)
- Certificate of Public Convenience and Necessity - Transmission Line of 138 kilovolts or more and more than 5280 feet in length - Notice of Intent: (PDF File), (Word File)
- Certificate of Public Convenience and Necessity - Transmission Line of 138 kilovolts or more and more than 5280 feet in length: (PDF File), (Word File)
- Farm-Tap Rate Adjustment: (PDF File), (Word File)
- Financing: (PDF File), (Word File)
- General Rate Case Using a Fully-Forcasted Test Period (Except Sewers): (PDF File), (Word File)
- General Rate Case Using Historical Test Period (Except Sewers): (PDF File), (Word File)
- Non-Recurring Charges: (PDF File), (Word File)
-
- Notice of Intent to File: (PDF format), (Word format)
- Application for a Merchant Electric Generating Facility Construction Certification: (PDF Format), (Word format)
- Application for a Nonregulated Electric Transmission Line Construction Certification: (PDF Format), (Word format)
- Purchased Water Adjustment - Privately Owned Companies: (PDF File), (Word File)
- Purchased Water Adjustment - Water Districts & Associations: (PDF File), (Word File)
- Treated Sewage Adjustment - Water Districts & Associations: (PDF File), (Word File)
- Initial Approval of Water District Commissioners' Training Program: (PDF File), (Word File)
- Transfers: (PDF File), (Word File)
-
-
- Investor-Owned Electric Utilities: (PDF format), (Word format)
- Rural Electric Utilities: (PDF format), (Word format)
- Gas: (PDF format), (Word format)
- Radio-Telephone Utilities: (PDF format), (Word format)
- Cellular Telephone Utilities: (PDF format), (Word format)
- Personal Communication Services (PCS) Utilities: (PDF format), (Word format)
- Local Exchange Carriers (LEC): (PDF format), (Word format)
- Competitive Local Exchange Carriers (CLEC): (PDF format), (Word format)
- Long Distance Telecommunication Utilities: (PDF format), (Word format)
- Operator Services Telecommunication Utilities: (PDF format), (Word format)
- Privately-Owned Water Utilities: (PDF format), (Word format)
- Water Districts: (PDF format), (Word format)
- Water Associations: (PDF format), (Word format)
- Sewer: (PDF format), (Word format)
- Nonrecurring Charge Cost Justification: (PDF format), (Word format)
- Notice of Election to use Electronic Filing Procedures: (PDF format)
- Open Records Request Form: (PDF Format), (Word format)
-
Tariff Forms:
- Tariff Form 1 (sample), (blank)
- Tariff Form 2 General Page(PDF format), General Page (Word format)
- Tariff Form 3 Adoption(PDF format), Adoption (Word format)
-
- Investor-Owned Electric Utilities
- Rural Electric Utilities
- Gas - Class A & B
- Gas - Class C
- Telephone
- Revised 2002 - Water Companies - Class A & B
- Revised 2002 - Water Companies - Class C
- Revised 2002 - Water Districts/Associations - Class A & B
- Revised 2002 - Water Districts/Associations - Class C
- Sewer Utilities (9.77MB)
- Subpoena Form: (PDF format)
Electric Specific Forms
- Annual Distribution Reliability Form
-
- Notice of Intent to File: (PDF format), (Word format)
- Application for a Merchant Electric Generating Facility Construction Certification: (PDF Format), (Word format)
- Application for a Nonregulated Electric Transmission Line Construction Certification: (PDF Format), (Word format)
- Quarterly Electric Meter Testing Report New Please contact Division of Inspections about filing online.
-
Incident Reporting:
For use by utilities notifying the PSC of specific incidents pursuant to regulatory requirements.
Members of the Public reporting incidents or hazardous situations please call 911 or your local emergency responders
- Outage Reporting System
- Incident Reporting Regulations - Section 27: https://apps.legislature.ky.gov/law/kar/807/005/006.pdf
807 KAR 5:006, Section 27 requires each utility, other than a natural gas utility, to notify the Commission, within two (2) hours of discovery by the utility, of any utility related accident which results in:
- (a) Death; or shock or burn requiring medical treatment at a hospital or similar medical facility, or any accident requiring in-patient overnight hospitalization;
- (b) Actual or potential property damage of $25,000 or more; or
- (c) Loss of service for four (4) or more hours to ten (10) percent or five hundred (500) or more of the utility's customers, whichever is less.
Notification pursuant to 807 KAR 5:006, Section 27 is to be provided:
- By Telephone: 502-782-7905
- By Email: [email protected]
- Outage Reporting System
Gas Specific Forms
- New Facility Locate Agreement FAQ: PDF format
- New Facility Locate Agreement Form: PDF format
- Quarterly Report of Gas Cost Recovery Rate Calculation: Blank form in Word format, Blank form in PDF format
-
Incident Reporting:
For use by utilities notifying the PSC of specific incidents pursuant to regulatory requirements.
Members of the Public reporting incidents or hazardous situations please call 911 or your local emergency responders
- Incident Reporting Regulations: https://apps.legislature.ky.gov/law/kar/807/005/027.pdf
Telecom Specific Forms
- Information Form Pursuant to KRS 278.541 - 278.544: (PDF format), (Word format)
- Public Interest Payphone Application: Blank form in Word format Blank form in PDF format
-
- To make a Relay Call, most people (TDD users and hearing people) just need to dial 7-1-1. For more details and to see what other features of the Kentucky Relay Service might be best for you, please visit the Kentucky Relay Website.
- For information about the Telecommunications Access Program please visit the Kentucky Commission on the Deaf and Hard of Hearing's website
- To register to submit Electronic Payments Register with kentucky.gov
- To Remit Telecommunications Relay Service and Telecommunications Access Program Surcharges (TRS/TAP)
- Administrative Case 2007-00464 February 16, 2009
- Administrative Case No. 372 Decisions
-
-
2024 Forms:
(PDF format),
(Word format),
Instructions (pdf format)
Annual High-Cost Certifications pursuant to 47 CFR Section 54.314
The Commission, pursuant to 47 CFR Section 54.314, must certify annually to USAC and the FCC the use of High-cost funds and that those funds are used properly. The Commission certifies each Eligible Telecommunications Carrier’s (ETC) proper use of the funds received. The certification is due October 1st of each calendar year.
ETCs in Kentucky receiving High-cost funds shall file with the Commission, by email, an affidavit certifying that all federal High-cost support was used in the preceding calendar year and will be used in the coming calendar year only for the provision, maintenance, and upgrading of facilities and services for which the support is intended. The ETC shall specify in its affidavit the ETC’s study area code (SAC) and SAC number.
Email all affidavits to the Commission by September 15th. The affidavits should be in PDF format and emailed to [email protected]. A copy should also be emailed to [email protected].
Questions may be directed to J.E.B. Pinney at [email protected] or at (502) 782-2587.
- Administrative Commission Decisions
-
2024 Forms:
(PDF format),
(Word format),
Instructions (pdf format)
-
Incident Reporting:
For use by utilities notifying the PSC of specific incidents pursuant to regulatory requirements.
Members of the Public reporting incidents or hazardous situations please call 911 or your local emergency responders
- Outage Reporting System
- Incident Reporting Regulations - Section 27: https://apps.legislature.ky.gov/law/kar/807/005/006.pdf
Water Specific Forms
- Water Use & Loss Calculations: (Excel format), HELP - How To Complete Form
- Surcharge Reporting: (Excel format)
- Average Meter Connnection Expense Cost Justification (Tap Fee): (PDF format), (Word format)
- PSC Guidance on Municipal Utility Rate Adjustment (letter of 12/18/98) (PDF format)
- Purchased Water Adjustment (Privately Owned Companies): (PDF format), (Word format)
- Purchased Water Adjustment (Water Districts and Associations): (PDF format), (Word format)
- Quarterly Water Meter Testing Report: (PDF format), (Excel format)
- Water Storage Requirement Deviation Request: (PDF format), (Word format)
- Components of a Water Loss Prevention Plan
- Tariff Samples
-
Incident Reporting:
For use by utilities notifying the PSC of specific incidents pursuant to regulatory requirements.
Members of the Public reporting incidents or hazardous situations please call 911 or your local emergency responders
- Incident Reporting Regulations - Section 27: https://apps.legislature.ky.gov/law/kar/807/005/006.pdf
Sewer Specific Forms
- Sample Safety Manual
- Sewer Daily Log: (PDF format), (Excel Format)
- Sewer Inspection Procedures: (PDF Format), (Word format)
- Treated Sewage Adjustment: (PDF Format), (Word format)
-
Incident Reporting:
For use by utilities notifying the PSC of specific incidents pursuant to regulatory requirements.
Members of the Public reporting incidents or hazardous situations please call 911 or your local emergency responders
- Incident Reporting Regulations - Section 27: https://apps.legislature.ky.gov/law/kar/807/005/006.pdf