Application Form

This document pretains to DNC-NEW-INTR2009-02077 for New Application on a Data Network Code filing.

Approved by OMB
3060-1029
DATA NETWORK IDENTIFICATION CODE FILING
FOR OFFICIAL USE ONLY

APPLICANT INFORMATION


1. Applicant
BRAIN BRAIN --
PO BOX 1112
WOODSTOCK IL
USA 60098 -1112
Ms BRAIN BRAIN
2. Contact
BRAIN GAYLORD 224-356-4947
BRAIN BRAIN 224-356-4947
PO BOX 1112 [email protected]
WOODSTOCK IL
USA 60098 -1112
BRAIN BRAIN Same
3. Type Request
New Reassign
Note: Please submit any needed attachments for the given request type:
FCN
BRAIN GAYLORD BRAIN
CARRIER
DNIC CODE ASSIGNMENT
8. Code assignments held in excess of 18 months without implementation must be returned to this Administrator for reassignment. Unless this office is specifically notified of the actual implementation of assignments, it will be assumed that those implementations did not occur and such assignments will be available for reassignment. I have read and understand these conditions. Yes No
9. I am aware that all DNIC assignments are provisional and that nobody has a property right in a DNIC. I am aware that the Commision may take an assigned DNIC and reassign it to another person. Yes No
10. I certify that all necessary local, state, and federal authorizations needed have been obtained. Yes No
WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND / OR IMPRISONMENT
(U.S. Code, Title 18, Section 1001), AND/OR REVOCATION OF ANY STATION AUTHORIZATION
(U.S. Code, Title 47, Section 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503).



The public reporting for this collection of information is estimated to average less than 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the required data, and completing and reviewing the collection of information. If you have any comments on this burden estimate, or how we can improve the collection and reduce the burden it causes you, please write to the Federal Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-1029), Washington, DC 20554. We will also accept your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet if you send them to [email protected]. PLEASE DO NOT SEND COMPLETED FORMS TO THIS ADDRESS.

Remember - You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-1029.


© 2024 FCC.report
This site is not affiliated with or endorsed by the FCC