Form FCC Form 312-EZ FCC Form 312-EZ Qualification Questions

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(Commision Registration
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Site

Points of Comm

Antenna

Frequency

Frequency Coord

Administrative

Qualifications

Certification

Attachments

Station

Summary
File Number:

Date Filed:

Call Sign:
Status:

Status Date:

Last Action:

Action Date:

AFPN Date:

ATPN Date:

Begin Date:

Expiration Date:

Description

ASR
(Antenna Structure
Registration)

Applicant/Licensee
FRN:

Attn. Phone:

Contact Name:

Attn. Fax:

Company:

Attn. E-mail:

Street 1:

Attention:

FCC E-Filing Systems
(FCC Electronic filing
Systems)

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NNN-NNN-NNNN xNNN
NNN-NNN-NNNN xNNN

-- x
--

Street 2:
City, State, Zip:
Corp. Phone:
Corp. Fax:
Corp. E-mail:

Monday-Friday
9:30am-4:00pm

Contact

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Page 2 of 2

FRN:

Contact Attn.:

Contact Name:

Contact Attn. Phone:

Company:

Contact Attn. Fax:

Street 1:

Contact Attn. E-mail:

NNN-NNN-NNNN xNNN
NNN-NNN-NNNN xNNN

-- x
--

Street 2:
City, State, Zip:
Corp. Phone:
Corp. Fax:
Corp. E-mail:

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Qualifications

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No. Question
1.
Are you applying for a NEW earth station license or registration (i.e., one that has not been previously
licensed or registered?)
2.

Will your proposed earth station be a fixed earth station or temporary-fixed earth station ( not part of a
VSAT network) that will operate only in the Fixed Satellite Service?

3.

Which band will your proposed earth station be operating in?

RELATED SYSTEMS
CORES

4.

Have you completed Frequency Coordination and will you be attaching a Frequency Coordination Report
to this application?

(Commision Registration
System)

5.

ASR

6.

Does your proposed earth station and its operation conform to all technical, procedural, and operational
requirements of the FCC Rules and Regulations (47 CFR) and therefore requires NO waivers or
exemptions from any of the Commission's Rules?

7.

Does your proposed antenna(s) comply with the antenna gain standard specified in Section 25.209(a) and
(b) as demonstrated by the manufacturer's qualification measurements?

8.

Does your proposed earth station operation conform with all routine power and power density rules
contained in Sections 25.211 and 25.212?

9.

Can you certify that FAA notification is not required under 47 CFR Part 17 and 47 CFR Section
25.113(c)?

11.

Do you certify that Commission grant of any proposal in this application will NOT have a significant
environmental impact as defined by 47 CFR Section 1.1307?

12.

Are you asking for a:

13.

Has a Radiation Hazard Study (refer to OET bulletin 65) been completed and will this Radiation Hazard
Study be attached as an exhibit to this application?

14.

Do you certify that you are not a foreign government or a representative of a foreign government?

15.

Do you certify that you are not an alien, or the representative of an alien?

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Will you operate your proposed earth station ONLY with U.S.-licensed or Permitted List geostationary

satellites (within the parameters specified on the Permitted List)?

(Antenna Structure
Registration)

(FCC Electronic filing
Systems)

Answer

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Qualifications

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16.

Do you certify that you are not a corporation organized under the laws of any foreign government?

17.

Do you certify that you are not 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 corporation organized under the laws of a foreign country?

18.

Do you certify that you are not 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 country?

19.

Do you certify that the applicant or any party to this application has NOT had any FCC station authorization
or license revoked or had any application for an initial, modification or renewal of FCC station
authorization, license or construction permit denied by the Commission?

20.

Do you certify that neither you nor any party to this application, nor any party directly or indirectly
controlling your company, has EVER been convicted of a felony by any state or federal court?

21.

Do you certify that NO court has finally adjudged the applicant, or any person directly or indirectly
controlling the applicant, guilty of unlawfully monopolizing or attempting 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?

22.

Do you certify that neither you nor any person directly or indirectly controlling the applicant, is currently a
party in any pending matter referred to in the preceding two items?

23.

Does the undersigned certify that neither the 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
substance? See 47 CFR Section 1.2002(b) for the meaning 'party to the application' for these
purposes.

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Certification

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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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CORES

Type of Applicant

(Commision Registration
System)

Applicant Other Text
If other, describe the type of applicant.

Signer Name

ASR
(Antenna Structure
Registration)

Signer Title

FCC E-Filing Systems
(FCC Electronic filing
Systems)

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Signature

Date Signed (XX/XX/XXXX)

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 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

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Certification

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collection and reduce the burden it causes you, please write to the Federal Communications Commission, AMDPERM,
Paperwork Reduction Project (3060-1067), 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 orsponsor 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 3060-1067.
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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Attachments

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Select

c
d
e
f
g
c
d
e
f
g

Attachment Type
Frequency Coordination Report

File Name

Date Uploaded

Replace/Attach

Radiation Hazard Study

RELATED SYSTEMS
CORES
(Commision Registration
System)

ASR
(Antenna Structure
Registration)

FCC E-Filing Systems
(FCC Electronic filing
Systems)

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Monday-Friday
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Station

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RELATED SYSTEMS
CORES

Satellite Orbit Type

(Commision Registration
System)

Class of Earth Station

ASR

Nature of Service
Status

Filing Classification

(Antenna Structure
Registration)

Satellite Name

FCC E-Filing Systems

Frequency Band(s)

(FCC Electronic filing
Systems)

Type of Earth Station Facility

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E-Mail Us
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PN Description

Call Us
IBFS Help Line
202-418-2222
Monday-Friday
9:30am-4:00pm

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Site

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RELATED SYSTEMS
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Administrative

Qualifications

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Attachments

Station

Site

Points of Comm

Antenna

Frequency

Frequency Coord

Contact Phone:
Site ID:

Area of Operation:

(Antenna Structure
Registration)

NNN-NNN-NNNN xNNN

N/A

Street 1:

State:

Street 2:

City:

County:

Zip Code:

(Commision Registration
System)

ASR

Contact Name:

Deg.

Min.

Sec.

Latitude:
Longitude:

N/A

Hem.
N/A

NAD Indicator:
N/A

N/A

Elevation (meters):

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Systems)

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Points of Comm

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Frequency Coord

Select

Site Id

Point of Communication

c
d
e
f
g

None

PERMITTED LIST

RELATED SYSTEMS
CORES
(Commision Registration
System)

ASR
(Antenna Structure
Registration)

FCC E-Filing Systems
(FCC Electronic filing
Systems)

CONTACT US
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Points of Comm

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Site

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Frequency Coord

Select

Site Id

Point of Communication

c
d
e
f
g

None

PERMITTED LIST

RELATED SYSTEMS
CORES
(Commision Registration
System)

ASR
(Antenna Structure
Registration)

FCC E-Filing Systems
(FCC Electronic filing
Systems)

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Frequency

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Not Assigned

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Site

Points of Comm

Antenna

Frequency

Frequency Coord

Select

c
d
e
f
g
RELATED SYSTEMS
CORES
(Commision Registration
System)

Antenna ID

T/R Mode

Freq Lower (MHz/GHz)

Freq Upper (MHz/GHz)

Emission Designator

Describe Modulation & Services

Antenna Polarization

Max EIRP per Carrier (dBW)

Freq Unit

Max EIRP Density per Carrier
(dBW/4kHz)

None

ASR
(Antenna Structure
Registration)

FCC E-Filing Systems
(FCC Electronic filing
Systems)

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Frequency Coord

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Frequency Coord

Select

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d
e
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g
RELATED SYSTEMS
CORES

Antenna ID

Trans/Rec Mode

Lower Freq Limit (MHz)

Satellite Arc East Limit (Deg)

Satellite Arc West Limit (Deg)

Ant Elev Angle E (Deg)

Ant Elev Angle W (Deg)

Azimuth Angle E (Deg)

Upper Freq Limit (MHz)

Azimuth Angle W (Deg)

Max EIRP Density to Horizon (dBW/4KHz)

(Commision Registration
System)

ASR
(Antenna Structure
Registration)

FCC E-Filing Systems
(FCC Electronic filing
Systems)

CONTACT US
E-Mail Us
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Call Us
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