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<br />FCC NOTICE FOR INDIVIDUALS REQUIRED BY THE PRIVACY ACT AND THE PAPERWORK REDUCTION ACT <br /> <br />Part 54 of the Commission’s Rules authorizes the FCC to collect the information on this form. Failure to <br />provide all requested information will delay the processing of the application or result in the application <br />being returned without action. Information requested by this form will be available for public inspection. <br />Your response is required to obtain the requested authorization. <br /> <br />The public reporting for this collection of information is estimated to be 1 hour per response, including the <br />time for reviewing instructions, searching existing data sources, gathering and maintaining the required <br />data, and completing and reviewing the collection of information. If you have any comments on this <br />burden estimate, or how we can improve the collection and reduce the burden it causes you, please write <br />to the Federal Communications Commission, AMD-PERM, Paperwork Reduction Act Project (3060-0853), <br />Washington, DC 20554. We will also accept your comments regarding the Paperwork Reduction Act <br />aspects of this collection via the Internet if you send them to PRA@fcc.gov. PLEASE DO NOT SEND <br />YOUR RESPONSE TO THIS FORM TO THIS ADDRESS. <br /> <br />Remember - You are not required to respond to a collection of information sponsored by the Federal <br />government, and the government may not conduct or sponsor this collection, unless it displays a currently <br />valid OMB control number or if we fail to provide you with this notice. This collection has been assigned <br />an OMB control number of 3060-0853. <br />THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31, 1974, 5 U.S.C. <br />552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, <br />1995, 44 U.S.C. SECTION 3507. <br /> <br /> <br />A paper copy of this form, with a signature in Block 2, Item 7, must be mailed or delivered to your Billed Entity. <br /> <br /> <br />Page 23 of 29