Application Form [pdf]

This document pretains to SES-LIC-20070810-01079 for License on a Satellite Earth Station filing.

IBFS_SESLIC2007081001079_584727

                                                                                                     Approved by OMB
                                                                                                            3060−0678

Date & Time Filed: Aug 9 2007 5:12:08:233PM
File Number: SES−LIC−INTR2007−01899
Callsign/Satellite ID:


                     APPLICATION FOR EARTH STATION AUTHORIZATIONS               FCC Use Only

                        FCC 312 MAIN FORM FOR OFFICIAL USE ONLY

APPLICANT INFORMATION
Enter a description of this application to identify it on the main menu:
SeaTel 4006, Kent, WA
1−8. Legal Name of Applicant

           Name:         The Boeing Company                Phone Number:   866−248−1493
           DBA                                             Fax Number:     206−544−6592
           Name:
           Street:       Attn                              E−Mail:         bob.douglass@boeing.com
                         PO Box 3707
           City:         Seattle                           State:          WA
           Country:      USA                               Zipcode:        98124       −2207
           Attention:    Mr Robert B Douglass




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9−16. Name of Contact Representative

          Name:        Ron Center                    Phone Number:   206−544−6583
          Company: The Boeing Company                Fax Number:     206−544−6592
          Street:      P.O. Box 3707                 E−Mail:         ronald.e.center@boeing.com


          City:        Seattle                       State:          WA
          Country:      USA                          Zipcode:        98258−2207
          Attention:   Frequency Manager M/C 2T−22   Relationship:   Same




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CLASSIFICATION OF FILING
    17. Choose the button next to the                b.
    classification that applies to this filing for          b1. Application for License of New Station
    both questions a. and b. Choose only one
                                                            b2. Application for Registration of New Domestic Receive−Only Station
    for 17a and only one for 17b.
                                                     (N/A) b3. Amendment to a Pending Application
    a.                                               (N/A) b4. Modification of License or Registration
          a1. Earth Station                          (N/A) b5. Assignment of License or Registration
                                                     (N/A) b6. Transfer of Control of License or Registration
    (N/A) a2. Space Station                          (N/A) b7. Notification of Minor Modification
                                                     (N/A) b8. Application for License of New Receive−Only Station Using Non−U.S. Licensed
                                                     Satellite
                                                     (N/A) b9. Letter of Intent to Use Non−U.S. Licensed Satellite to Provide Service in the United
                                                     States
                                                          b10. Other (Please specify)
                                                            b11. Application for Earth Station to Access a Non−U.S.satellite Not Currently Authorized to
                                                     Provide the Proposed Service in the Proposed Frequencies in the United States.
                                                           b12. Application for Database Entry
                                                          (N/A) b13. Amendment to a Pending Database Entry Application
                                                          (N/A) b14. Modifiction of Database Entry
         17c. Is a fee submitted with this application?
          If Yes, complete and attach FCC Form 159.          If No, indicate reason for fee exemption (see 47 C.F.R.Section 1.1114).
          Governmental Entity          Noncommercial educational licensee
          Other(please explain):

    17d.

    Fee Classification BAX − Fixed Satellite Transmit/Receive Earth
    Station




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    18. If this filing is in reference to an   19. If this filing is an amendment to a pending application enter:
    existing station, enter:
                                               (a) Date pending application was filed:            (b) File number of pending application:
    (a) Call sign of station:
    Not Applicable                             Not Applicable                                     Not Applicable



TYPE OF SERVICE
20. NATURE OF SERVICE: This filing is for an authorization to provide or use the following type(s) of service(s): Select all that apply:


       a. Fixed Satellite
       b. Mobile Satellite
       c. Radiodetermination Satellite
       d. Earth Exploration Satellite
       e. Direct to Home Fixed Satellite
       f. Digital Audio Radio Service
       g. Other (please specify)

21. STATUS: Choose the button next to the applicable status. Choose        22. If earth station applicant, check all that apply.
only one.                                                                       Using U.S. licensed satellites
      Common Carrier        Non−Common Carrier                                  Using Non−U.S. licensed satellites

23. If applicant is providng INTERNATIONAL COMMON CARRIER service, see instructions regarding Sec. 214 filings. Choose one. Are these
facilities:
           Connected to a Public Switched Network Not connected to a Public Switched Network     N/A




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    24. FREQUENCY BAND(S): Place an "X" in the box(es) next to all applicable frequency band(s).
      a. C−Band (4/6 GHz)  b. Ku−Band (12/14 GHz)
      c.Other (Please specify upper and lower frequencies in MHz.)
        Frequency Lower: Frequency Upper:


TYPE OF STATION
25. CLASS OF STATION: Choose the button next to the class of station that applies. Choose only one.
          a. Fixed Earth Station
          b. Temporary−Fixed Earth Station
          c. 12/14 GHz VSAT Network
          d. Mobile Earth Station
(N/A) e. Geostationary Space Station
(N/A) f. Non−Geostationary Space Station
         g. Other (please specify)


26. TYPE OF EARTH STATION FACILITY: Choose only one.
      Transmit/Receive Transmit−Only  Receive−Only                    N/A


PURPOSE OF MODIFICATION

27. The purpose of this proposed modification is to: (Place an ’X’ in the box(es) next to all that apply.)


Not Applicable




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ENVIRONMENTAL POLICY

28. Would a Commission grant of any proposal in this application or amendmenthave a significant                              Yes        No
environmental impact as defined by 47 CFR 1.1307? If YES, submit thestatement as required by Sections
1.1308 and 1.1311 of the Commission’s rules,47 C.F.R. §§ 1.1308 and 1.1311, as an exhibit to this                      RADHAZ
application.A Radiation Hazard Studymust accompany all applications for new transmitting facilities, major
modifications,or major amendments.



ALIEN OWNERSHIP Earth station applicants not proposing to provide broadcast, common carrier, aeronautical en route or
aeronautical fixed radio station services are not required to respond to Items 30−34.

29. Is the applicant a foreign government or the representative of any foreign government?                             Yes         No




30. Is the applicant an alien or the representative of an alien?                                                       Yes         No   N/A




31. Is the applicant a corporation organized under the laws of any foreign government?                                 Yes         No   N/A




32. Is the applicant a corporation of which more than one−fifth of the capital stock is owned of record or voted by    Yes         No   N/A
aliens or their representatives or by a foreign government or representative thereof or by any corporation organized
under the laws of a foreign country?




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33. Is the applicant a corporation directly or indirectly controlled by any other corporation of which more than          Yes         No   N/A
one−fourth of the capital stock is owned of record or voted by aliens, their representatives, or by a foreign
government or representative thereof or by any corporation organized under the laws of a foreign country?



34. If any answer to questions 29, 30, 31, 32 and/or 33 is Yes, attach as an exhibit an identification of the aliens or
foreign entities, their nationality, their relationship to the applicant, and the percentage of stock they own or vote.



BASIC QUALIFICATIONS

35. Does the Applicant request any waivers or exemptions from any of the Commission’s Rules?                                    Yes        No
If Yes, attach as an exhibit, copies of the requests for waivers or exceptions with supporting documents.




36. Has the applicant or any party to this application or amendment had any FCC station authorization or license                Yes        No
revoked or had any application for an initial, modification or renewal of FCC station authorization, license, or
construction permit denied by the Commission? If Yes, attach as an exhibit, an explination of circumstances.




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37. Has the applicant, or any party to this application or amendment, or any party directly or indirectly controlling            Yes         No
the applicant ever been convicted of a felony by any state or federal court? If Yes, attach as an exhibit, an
explination of circumstances.
                                                                                                                         Felony Disclosure



38. Has any court finally adjudged the applicant, or any person directly or indirectly controlling the applicant,                Yes         No
guilty of unlawfully monopolizing or attemptiing unlawfully to monopolize radio communication, directly or
indirectly, through control of manufacture or sale of radio apparatus, exclusive traffic arrangement or any other
means or unfair methods of competition?If Yes, attach as an exhibit, an explanation of circumstances




39. Is the applicant, or any person directly or indirectly controlling the applicant, currently a party in any pending           Yes         No
matter referred to in the preceding two items? If yes, attach as an exhinit, an explanation of the circumstances.




40. If the applicant is a corporation and is applying for a space station license, attach as an exhibit the names,
address, and citizenship of those stockholders owning a record and/or voting 10 percent or more of the Filer’s
voting stock and the percentages so held. In the case of fiduciary control, indicate the beneficiary(ies) or class of
beneficiaries. Also list the names and addresses of the officers and directors of the Filer.




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41. By checking Yes, the undersigned certifies, that neither applicant nor any other party to the application is                Yes          No
subject to a denial of Federal benefits that includes FCC benefits pursuant to Section 5301 of the Anti−Drug Act of
1988, 21 U.S.C. Section 862, because of a conviction for possession or distribution of a controlled substance. See
47 CFR 1.2002(b) for the meaning of "party to the application" for these purposes.



42a. Does the applicant intend to use a non−U.S. licensed satellite to provide service in the United States? If Yes,            Yes          No
answer 42b and attach an exhibit providing the information specified in 47 C.F.R. 25.137, as appropriate. If No,
proceed to question 43.




42b. What administration has licensed or is in the process of licensing the space station? If no license will be issued, what administration has
coordinated or is in the process of coordinating the space station?




43. Description. (Summarize the nature of the application and the services to be provided).                      (If the complete description does
not appear in this box, please go to the end of the form to view it in its entirety.)
    This application is for operation of a Seatel Model 4006, fixed satellite earth station at
    the Boeing facility in Kent, WA.



                    Two Degree Showing




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43a. Geographic Service Rule Certification                                                                                        A
By selecting A, the undersigned certifies that the applicant is not subject to the geographic service or geographic
coverage requirements specified in 47 C.F.R. Part 25.
                                                                                                                                  B
By selecting B, the undersigned certifies that the applicant is subject to the geographic service or geographic
coverage requirements specified in 47 C.F.R. Part 25 and will comply with such requirements.
                                                                                                                                  C
By selecting C, the undersigned certifies that the applicant is subject to the geographic service or geographic
coverage requirements specified in 47 C.F.R. Part 25 and will not comply with such requirements because it is not
feasible as a technical matter to do so, or that, while technically feasible, such services would require so many
compromises in satellite design and operation as to make it economically unreasonable. A narrative description
and technical analysis demonstrating this claim are attached.




CERTIFICATION
The Applicant waives any claim to the use of any particular frequency or of the electromagnetic spectrum as against the regulatory power of the
United States because of the previous use of the same, whether by license or otherwise, and requests an authorization in accordance with this
application. The applicant certifies that grant of this application would not cause the applicant to be in violation of the spectrum aggregation limit
in 47 CFR Part 20. All statements made in exhibits are a material part hereof and are incorporated herein as if set out in full in this application.
The undersigned, individually and for the applicant, hereby certifies that all statements made in this application and in all attached exhibits are
true, complete and correct to the best of his or her knowledge and belief, and are made in good faith.




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44. Applicant is a (an): (Choose the button next to applicable response.)

      Individual
      Unincorporated Association
      Partnership
      Corporation
      Governmental Entity
      Other (please specify)




     45. Name of Person Signing                                             46. Title of Person Signing
     Robert B Douglass                                                      Manager, Spectrum Management


47. Please supply any need attachments.
 Attachment 1:                                    Attachment 2:                                 Attachment 3:




            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).




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                                             SATELLITE EARTH STATION AUTHORIZATIONS
                                      FCC Form 312 − Schedule B:(Technical and Operational Description)
                                                         FOR OFFICIAL USE ONLY



Location of Earth Station Site

E1: Site Identifier: SeaTel Kent           E5. Call Sign:
E2: Contact Name Margaret Mead             E6. Phone          253−773−4175
                                           Number:
E3. Street:          20403 68th Ave S      E7. City:          Kent

                                           E8. County:        King

E4. State            WA                    E9. Zip Code       98032

E10. Area of Operation:                    Kent, Wa
E11. Latitude:       47 °25 ’7.5 "N
E12. Longitude:      122 °15 ’11.2 "W
E13. Lat/Lon Coordinates are:                 NAD−27             NAD−83              N/A


E14. Site Elevation (AMSL):                8.23 meters




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E15. If the proposed antenna(s) operate in the Fixed Satellite Service (FSS) with geostationary satellites, do(es) the
proposed antenna(s) comply with the antenna gain patterns specified in Section 25.209(a) and (b) as demonstrated         Yes   No        N/A
by the manufacturer’s qualification measurement? If NO, provide asAntenna Pattern a technical analysis showing
compliance with two−degree spacing policy.


E16. If the proposed antenna(s) do not operate in the Fixed Satellite Service (FSS), or if they operate in the Fixed
Satellite Service (FSS) with non−geostationary satellites, do(es) the proposed antenna(s) comply with the antenna        Yes   No        N/A
gain patterns specified in Section 25.209(a2) and (b) as demonstrated by the manufacturer’s qualification
measurements?


E17. Is the facility operated by remote control? If YES, provide the location and telephone number of the control
point.                                                                                                                   Yes        No




E18. Is frequency coordination required? If YES, attach a frequency coordination report as
                                                                                                                         Yes        No


E19. Is coordination with another country required? If YES, attach the name of the country(ies) and plot of
coordination contours as                                                                                                 Yes        No


E20. FAA Notification − (See 47 CFR Part 17 and 47 CFR part 25.113(c)) Where FAA notification is required, have
you attached a copy of a completed FCC Form 854 and or the FAA’s study regarding the potential hazard of the             Yes        No
structure to aviation?
FAILURE TO COMPLY WITH 47 CFR PARTS 17 AND 25 WILL RESULT IN THE RETURN OF THIS
APPLICATION.
 POINTS OF COMMUNICATION
Satellite Name:   ALSAT | ALL AUTHORIZED U.S. | ALSATIf you selected OTHER, please enter the following:




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E21. Common Name:                                                     E22. ITU Name:
E23. Orbit Location:                                                  E24. Country:
     POINTS OF COMMUNICATION (Destination Points)
E25. Site Identifier: SeaTel Kent
E26. Common Name:                                                     E27. Country:USA
 ANTENNA
Site ID                E28. Antenna Id    E29. Quantity      E30.              E31. Model         E32. Antenna      E41/42. Antenna
                                                             Manufacturer                         Size<meters>      GainTransmint
                                                                                                                    and/or Recieve
                                                                                                                    (____dBi at
                                                                                                                    _____GHz)
SeaTel Kent            SeaTel             1                  SeaTel            4006               1.0               40.1 dBi at 11.95


                                                                                                                    41.8 dBi at 14.25



E28. Antenna      E33/34.           E35. Above       E36. Above Sea E37. Building      E38. Total       E39.             E40. Total
Id                Diameter          Ground           Level<BR>      Height Above       Input Power at   Maximum          EIRP for al
                  Minor/Major       Level<BR>        (meters)       Ground             antenna          Antenna Height   carriers<BR>
                  (meters)          (meters)                        Level<BR>          flange<BR>       Above            (dBW)
                                                                    (meters)           (Watts)          Rooftop<BR>
                                                                                                        (meters)
SeaTel            1.0/1.0           3.0              11.23            0.0              8.0              0.0              50.83
FREQUENCY
E28. Antenna Id        E43/44.         E45. T/R Mode         E46. Antenna      E47. Emission      E48. Maximum     E49. Maximum
                       Frequency Bands                       Polarization(H,V, Designator         EIRP per Carrier ERIP Density per
                       (MHz)                                 L,R)                                 (dBW)            Carrier
                                                                                                                   (dBW/4kHz)



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SeaTel             11700            R                     Linear and Circular 11M9G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 1M00G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 1M50G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




15


SeaTel             11700            R                     Linear and Circular 20M0G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 24M3G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 256KG7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




16


SeaTel             11700            R                     Linear and Circular 29M5G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 2M00G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 32M4G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




17


SeaTel             11700            R                     Linear and Circular 3M00G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 4M00G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 512KG7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




18


SeaTel             11700            R                     Linear and Circular 5M00G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 6M75G7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             11700            R                     Linear and Circular 768KG7D                 0.0                   0.0
                   12200
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




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SeaTel             14000            T                     Linear and Circular 11M9G7D                 50.83                 16.1
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 1M00G7D                 42.5                  18.52
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 1M50G7D                 44.3                  18.56
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




20


SeaTel             14000            T                     Linear and Circular 20M0G7D                 50.83                 13.84
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 24M3G7D                 50.83                 12.99
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 256KG7D                 36.8                  18.74
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




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SeaTel             14000            T                     Linear and Circular 29M5G7D                 50.83                 12.15
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 2M00G7D                 45.3                  18.31
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 32M4G7D                 50.83                 11.75
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




22


SeaTel             14000            T                     Linear and Circular 3M00G7D                 47.3                  18.55
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 4M00G7D                 48.3                  18.3
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 512KG7D                 39.8                  18.73
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




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SeaTel             14000            T                     Linear and Circular 5M00G7D                 49.58                 18.61
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 6M75G7D                 50.83                 18.56
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




SeaTel             14000            T                     Linear and Circular 768KG7D                 41.3                  18.47
                   14500
E50. Modulation and Services   (If the complete description does not appear in this box, please go to the end of the form to view it in its
entirety.)
     Digital Data Carrier




FREQUENCY COORDINATION


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E28.             E51. Satellite E52/53.     E54/55.                E56. Earth      E57.            E58. Earth      E59.            E60.
Antenna Id       Orbit Type     Frequency   Range of               Station         Antenna         Station         Antenna         Maximum
                                Limits(MHz) Satellite Arc          Azimuth         Elevation       Azimuth         Elevation       EIRP Density
                                            E/W Limit              Angle           Angle           Angle           Angle           toward the
                                                                   Eastern Limit   Eastern Limit   Western         Western         Horizon
                                                                                                   Limit           Limit           (dBW/4kHz)


SeaTel           Geostationary 11700              53.0/ 180.0      105.6           5.2             245.1           12.7            0.0
                               12200
                 Geostationary 14000              53.0/ 180.0      105.6           5.2             245.1           12.7            −11.96
                               14500
REMOTE CONTROL POINT LOCATION
     E61. Call Sign                                                         E65. Phone Number

   NOTE: Please enter the callsign of the controlling station, not the
callsign for which this application is being filed.
     E62. Street Address



     E63. City                                       E67. County                                      E64/68.                  E66. Zip Code
                                                                                                   State/Country
                                                                                                      /




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FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT

The public reporting for this collection of information is estimated to average 2 hours 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 (3060−0678), 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 jboley@fcc.gov. 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 3060−0678.

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.




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Document Created: 2019-04-12 08:41:50
Document Modified: 2019-04-12 08:41:50

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