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

Enter a description of this application to identify it on the main menu:

BRAIN BRAIN

1. Applicant Name: BRAIN BRAIN Phone Number: -- DBA Name: Fax Number: Street: PO BOX 1112 E-Mail: City: WOODSTOCK State: IL Country: USA Zipcode: 60098 -1112 Attention: Ms BRAIN BRAIN
2. Contact Name: BRAIN GAYLORD Phone Number: 224-356-4947 Company: BRAIN BRAIN Fax Number: 224-356-4947 Street: PO BOX 1112 E-Mail: [email protected] City: WOODSTOCK State: IL Country: USA Zipcode: 60098 -1112 Attention: BRAIN BRAIN Relationship: Same
3. Type Request New Reassign Note: Please submit any needed attachments for the given request type: Attachment 1: FCN Attachment 2: Attachment 3:	4. Reassign Reason: From Company: To Company: From Code: To Code:
5. Network Name BRAIN GAYLORD BRAIN
6. International Service CARRIER
7. Action Requested 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).

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT 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. THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.