USAC was created in 1997 as a not-for-profit subsidiary of the National Exchange Carrier Association (NECA). USAC is an independent, not-for-profit corporation designated by the Federal Communications Commission (FCC) as the administrator of universal service. Telecommunications companies are required to make universal service contributions under the Telecommunications Act of 1996. USAC administers the collection and disbursement of these contributions. Universal service is based on the principle that all Americans should have access to a baseline level of telecommunications service that furthers the public interest of keeping all Americans connected. This principle is the cornerstone of the Communications Act of 1934, which established universal service legislation and also created the Federal Communications Commission (FCC).

USAC works to protect the integrity of universal service through informing and educating program audiences, collecting and distributing contributions, and promoting program compliance. FCC universal service support programs are administered by three USAC divisions:
♦ High Cost and Low Income
♦ Schools and Libraries
♦ Rural Health Care

The Telecommunications Program (formerly known as the Primary Program) provides subsidies up to 100% to eligible Health Care Providers (HCPs) for telecommunications access services.  Applicants currently participating in the Rural Health Care (RHC) Program receive support for telecommunications (point-to-point) services through the Telecommunications Program.

As the newest component of the Rural Health Care (RHC) division, the HCF Program provides a 65% subsidy on eligible expenses related to broadband connectivity ("hotspots") and Internet access to both rural Health Care Providers (HCPs) and members of a national Consortium, which can include non-rural HCPs (if the Consortium has a 51% majority of rural sites).  Subsidized eligible expenses can include: the implementation of statewide and/or regional broadband networks, equipment installation, Internet circuitry, related telecomm equipment, and connection to network data centers.

The USAC Finance Division is responsible for the finances of the corporation including billing, collection, and disbursement of all funds for the FCC support programs.  The Information Systems Division is responsible for providing overall operating support to the corporation.  The Internal Audit Division is responsible for conducting audits of USAC, the support programs, and program beneficiaries.  The External Relations Division is responsible for communication with stakeholders including Congress, the FCC, the media, and program participants.  The Office of the General Counsel is responsible for providing legal advice and support to the corporation.  The Human Resources and Operations Division is responsible for managing employee- and facilities-related business.

Committees of the USAC Board of Directors govern the functions of each USAC division.  Each committee of the USAC Board oversees the budgets of its respective division and reports to the USAC Board.  USAC works to ensure that the process for program participants is streamlined and easy to use.  Each quarter, USAC reports data to the FCC on the collection, disbursement, and cost of administering universal service support, available in USAC FCC Filings.