Attachment Form 312/Schedule B

This document pretains to SES-STA-20170305-00232 for Special Temporal Authority on a Satellite Earth Station filing.

IBFS_SESSTA2017030500232_1197009

  Approved by OMB
         3060-0678

Date & Time Filed:
File Number: ---
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:
DRAFT FORM FOR 60-DAY STA
1-8. Legal Name of Applicant
Name:       Astronics AeroSat       Corporation                  Phone Number:          603-879-0205
 DBA
                                                                 Fax Number:
 Name:
 Street:      62 State Route 101A                                E-Mail:                Frank.Blanda@astronics.com
 City:        Amherst                                            State:                 NH
 Country:     USA                                                Zipcode:               03031 -2281
 Attention:   Frank J Blanda
9-16. Name of Contact Representative
Name:      Carlos Nalda                                      Phone Number:             5713325626
 Company:     LMI Advisors                                   Fax Number:
 Street:      8601 James Creek Drive                         E-Mail:                   cnalda@lmiadvisors.com
 City:        Springfield                                    State:                    VA
 Country:     USA                                            Zipcode:                  22152-
 Attention:   Mr. Carlos Nalda                               Relationship:             Other
                                                 CLASSIFICATION OF FILING
17. Choose the button next to the          b.
classification that applies to this filing     b1. Application for License of New Station
for both questions a. and b. Choose only
                                               b2. Application for Registration of New Domestic Receive-Only Station
one for 17a and only one for 17b.
                                           (N/A) b3. Amendment to a Pending Application
                                           (N/A) b4. Modification of License or Registration
a.
                                           (N/A) b5. Assignment of License or Registration
    a1. Earth Station                      (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.
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): DRAFT FORM
17d.
Fee Classification
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)
ESAA
21. STATUS: Choose the button next to the applicable status.           22. If earth station applicant, check all that apply.
Choose 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
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)ESAA
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
                                                   ENVIRONMENTAL POLICY
28. Would a Commission grant of any proposal in this application or amendment have a significant
environmental impact as defined by 47 CFR 1.1307? If YES, submit the statement as required by Sections                Yes      No
1.1308 and 1.1311 of the Commission's rules, 47 C.F.R. §§ 1.1308 and 1.1311, as an exhibit to this


application.A Radiation Hazard Study must 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 aliens or their representatives or by a foreign government or representative thereof or by any             Yes     No   N/A
corporation organized under the laws of a foreign country?

33. Is the applicant a corporation directly or indirectly controlled by any other corporation of which more
than 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            Yes     No   N/A
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 revoked or had any application for an initial, modification or renewal of FCC station authorization,        Yes     No
license, or construction permit denied by the Commission? If Yes, attach as an exhibit, an explination of
circumstances.

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

38. Has any court finally adjudged the applicant, or any person directly or indirectly controlling the
applicant, guilty of unlawfully monopolizing or attemptiing unlawfully to monopolize radio communication,
                                                                                                                    Yes     No
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
                                                                                                                    Yes     No
pending 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.

41. By checking Yes, the undersigned certifies, that neither applicant nor any other party to the application is
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          Yes     No
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     No
Yes, 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?Permitted        List
43. Description. (Summarize the nature of the application and the services to be provided).     DRAFT FORM FOR 60DAY STA
REQUEST.
43a. Geographic Service Rule Certification
By selecting A, the undersigned certifies that the applicant is not subject to the geographic service or                A
geographic coverage requirements specified in 47 C.F.R. Part 25.

By selecting B, the undersigned certifies that the applicant is subject to the geographic service or geographic         B
coverage requirements specified in 47 C.F.R. Part 25 and will comply with such requirements.

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        C
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.
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
 Frank Blanda                                                            CTO
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).

                    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:      AES1                                               E5. Call Sign:                E140087


 E2: Contact Name          Network Operations Center                       E6. Phone Number:            16038790205
 E3. Street:               62 State Route 101A                             E7. City:                    Amherst
                           Suite 2B                                        E8. County:
 E4. State                 NH                                              E9. Zip Code                 03031
 E10. Area of Operation:                                                   CONUS
 E11. Latitude:            0 ° 0 ' 0.0 "
 E12. Longitude:           0 ° 0 ' 0.0 "
 E13. Lat/Lon Coordinates are:                                                NAD-27                       NAD-83        N/A
 E14. Site Elevation (AMSL):                                               0.0 meters
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 by the manufacturer's qualification measurement? If NO, provide asa technical analysis           Yes   No N/A
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 gain patterns specified in Section 25.209(a2) and (b) as demonstrated by the manufacturer's          Yes   No N/A
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
                                                                                                                 Yes     No
as
E19. Is coordination with another country required? If YES, attach the name of the
                                                                                                                 Yes     No
country(ies) and plot of coordination contours as
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 structure to
                                                                                                                 Yes     No
aviation?
FAILURE TO COMPLY WITH 47 CFR PARTS 17 AND 25 WILL RESULT IN
THE RETURN OF THIS APPLICATION.
POINTS OF COMMUNICATION
Satellite Name:PERMITTED LIST | | If you selected OTHER, please enter the following:
E21. Common Name:                                                               E22. ITU Name:
E23. Orbit Location:                                                            E24. Country:
POINTS OF COMMUNICATION (Destination Points)
E25. Site Identifier: AES1
E26. Common Name:                                                                E27. Country:USA
ANTENNA
       E28.                                  E32.
 Site           E29.        E30.    E31.            E41/42. Antenna GainTransmint and/or
      Antenna                              Antenna
 ID           Quantity Manufacturer Model                Recieve(____dBi at _____GHz)
        Id                                   Size
                       Astronics
AES1 AES1     50                   HR6400 0.24     29.0 dBi at 14.47
                       AeroSat
                             E35.     E36.                 E38. Total                 E40.
                                            E37. Building             E39. Maximum Total
                            Above Above                   Input Power
 E28.                                       Height Above                 Antenna    EIRP for
         E33/34. Diameter Ground Sea                       at antenna
Antenna                                       Ground                   Height Above    al
        Minor/Major(meters) Level    Level                    flange
  Id                                            Level                    Rooftop    carriers
                           (meters) (meters) (meters)        (Watts)     (meters)


                                                                                                                         (dBW)
AES1        0.0/0.0                       0.0          0.0          0.0                35.0           0.0               45.16
FREQUENCY
  E28.      E43/44.      E45.                                                E47.    E48. Maximum E49. Maximum ERIP
                                     E46. Antenna
Antenna Frequency         T/R                                              Emission    EIRP per        Density per
                                Polarization(H,V,L,R)
   Id    Bands(MHz) Mode                                                  Designator Carrier(dBW) Carrier(dBW/4kHz)
AES1    10950 11200 R           Horizontal and Vertical                   48M6G7D 0.0             0.0
E50. Modulation and Services Digital Data Services
AES1    10950 11200 R           Horizontal and Vertical                   54M0G7D 0.0                       0.0
E50. Modulation and Services Digital Data Services
AES1    11450 12200 R           Horizontal and Vertical                   48M6G7D 0.0                       0.0
E50. Modulation and Services Digital Data Services
AES1    11450 12200 R           Horizontal and Vertical                   54M0G7D 0.0                       0.0
E50. Modulation and Services Digital Data Services
AES1    14000 14500 T           Horizontal and Vertical                   8M00G7D 45.16                     12.94
E50. Modulation and Services Digital Data Services
FREQUENCY COORDINATION
                                                  E54/55.      E56.              E58.
                                                                        E57.              E59.
                                                   Range       Earth             Earth
                                                                      Antenna           Antenna   E60. Maximum
 E28.     E51.       E52/53.                         of       Station           Station
                                                                      Elevation         Elevation  EIRP Density
Antenna Satellite   Frequency                     Satellite   Azimuth           Azimuth
                                                                        Angle            Angle      toward the
  Id    Orbit Type Limits(MHz)                      Arc        Angle             Angle
                                                                       Eastern          Western Horizon(dBW/4kHz)
                                                    E/W       Eastern           Western
                                                                        Limit             Limit
                                                   Limit       Limit             Limit
                                                  8.0/
AES1        Geostationary 10950 11200                         0.0         5.0           360.0   5.0           0.0
                                                  177.0
                                                  8.0/
            Geostationary 11450 12200                         0.0         5.0           360.0   5.0           0.0
                                                  177.0
                                                  8.0/
            Geostationary 14000 14500                         0.0         5.0           360.0   5.0           6.54
                                                  177.0
REMOTE CONTROL POINT LOCATION
REMOTE CONTROL POINT LOCATION
E61. Call Sign                                                                                  E65. Phone Number
E030279                                                                                         16038790205
NOTE: Please enter the callsign of the controlling station, not the callsign for which this
application is being filed.
E62. Street Address
NOC
E63. City                                                 E67. County                                   E64/68.         E66. Zip
Amherst                                                   Hillsborough                                  State/Country   Code
                                                                                                        NH/ USA         03031
                    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:      AES2                                             E5. Call Sign:               E140087
 E2: Contact Name          Network Operations Center                       E6. Phone Number:            16038790205
 E3. Street:               62 State Route 101A                             E7. City:                    Amherst
                           Suite 2B                                        E8. County:
 E4. State                 NH                                              E9. Zip Code                 03031
 E10. Area of Operation:                                                   CONUS
 E11. Latitude:            0 ° 0 ' 0.0 "
 E12. Longitude:           0 ° 0 ' 0.0 "
 E13. Lat/Lon Coordinates are:                                                NAD-27                       NAD-83        N/A
 E14. Site Elevation (AMSL):                                               0.0 meters
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 by the manufacturer's qualification measurement? If NO, provide asa technical analysis           Yes   No N/A
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 gain patterns specified in Section 25.209(a2) and (b) as demonstrated by the manufacturer's          Yes   No N/A
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
                                                                                                                 Yes     No
as
E19. Is coordination with another country required? If YES, attach the name of the
                                                                                                                 Yes     No
country(ies) and plot of coordination contours as
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 structure to
aviation?                                                                                                        Yes     No
FAILURE TO COMPLY WITH 47 CFR PARTS 17 AND 25 WILL RESULT IN
THE RETURN OF THIS APPLICATION.
POINTS OF COMMUNICATION
Satellite Name: If you selected OTHER, please enter the following:
E21. Common Name:                                             E22. ITU Name:
E23. Orbit Location:                                                            E24. Country:
POINTS OF COMMUNICATION (Destination Points)
E25. Site Identifier:
E26. Common Name:                                                                      E27. Country:
ANTENNA
       E28.                                  E32.
 Site           E29.        E30.     E31.            E41/42. Antenna GainTransmint and/or
      Antenna                              Antenna
 ID           Quantity Manufacturer Model                Recieve(____dBi at _____GHz)
        Id                                   Size
                       Astronics
AES2 AES2     50                    HR129 0.29     31.1 dBi at 14.000
                       AeroSat
                                                                                                                         E40.
                                             E35.        E36.      E37. Building         E38. Total       E39. Maximum
                                                                                                                         Total


 E28.    E33/34. Diameter    Above Above Height Above Input Power   Antenna    EIRP for
Antenna Minor/Major(meters) Ground Sea        Ground   at antenna Height Above    al
  Id                         Level    Level    Level      flange    Rooftop    carriers
                            (meters) (meters) (meters)   (Watts)    (meters)    (dBW)

AES2        0.0/0.0                       0.0          0.0          0.0                11.75          0.0             41.9
FREQUENCY
  E28.      E43/44.      E45.                                                E47.    E48. Maximum E49. Maximum ERIP
                                     E46. Antenna
Antenna Frequency         T/R                                              Emission    EIRP per        Density per
                                Polarization(H,V,L,R)
   Id    Bands(MHz) Mode                                                  Designator Carrier(dBW) Carrier(dBW/4kHz)
AES2    10950 11200 R           Horizontal and Vertical                   2M94G7D 0.0             0.0
E50. Modulation and Services Digital Data Services
AES2    10950 11200 R           Horizontal and Vertical                   48M6G7D 0.0                       0.0
E50. Modulation and Services Digital Data Services
AES2    10950 11200 R           Horizontal and Vertical                   54M0G7D 0.0                       0.0
E50. Modulation and Services Digital Data Services
AES2    11450 12200 R           Horizontal and Vertical                   2M94G7D 0.0                       0.0
E50. Modulation and Services Digital Data Services
AES2    11450 12200 R           Horizontal and Vertical                   48M6G7D 0.0                       0.0
E50. Modulation and Services Digital Data Services
AES2    11450 12200 R           Horizontal and Vertical                   54M0G7D 0.0                       0.0
E50. Modulation and Services Digital Data Services
AES2    14000 14500 T           Horizontal and Vertical                   4M92G7D 36.81                     6.71
E50. Modulation and Services Digital Data Services
AES2    14000 14500 T           Horizontal and Vertical                   8M00G7D 41.57                     9.35
E50. Modulation and Services Digital Data Services
FREQUENCY COORDINATION
                                                  E54/55.      E56.              E58.
                                                                        E57.              E59.
                                                   Range       Earth             Earth
                                                                      Antenna           Antenna   E60. Maximum
 E28.     E51.       E52/53.                         of       Station           Station
                                                                      Elevation         Elevation  EIRP Density
Antenna Satellite   Frequency                     Satellite   Azimuth           Azimuth
                                                                        Angle            Angle      toward the
  Id    Orbit Type Limits(MHz)                      Arc        Angle             Angle
                                                                       Eastern          Western Horizon(dBW/4kHz)
                                                    E/W       Eastern           Western
                                                                        Limit             Limit
                                                   Limit       Limit             Limit
                                                  8.0/
AES2        Geostationary 10950 11200                         0.0         5.0           360.0   5.0           0.0
                                                  177.0
                                                  8.0/
            Geostationary 11450 12200                         0.0         5.0           360.0   5.0           0.0
                                                  177.0
                                                  8.0/
            Geostationary 14000 14500                         0.0         5.0           360.0   5.0           -1.96
                                                  177.0
REMOTE CONTROL POINT LOCATION
REMOTE CONTROL POINT LOCATION
E61. Call Sign                                                                                  E65. Phone Number
E030279                                                                                         16038790205
NOTE: Please enter the callsign of the controlling station, not the callsign for which this
application is being filed.


E62. Street Address
NOC
E63. City                                    E67. County                              E64/68.         E66. Zip
Amherst                                      Hillsborough                             State/Country   Code
                                                                                      NH/ USA         03031
FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT

The public reporting for this collection of information is estimated to average 0.25 - 24 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 PRA@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.



Document Created: 0800-04-24 00:00:00
Document Modified: 0800-04-24 00:00:00

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