FS-2700-10a Telecommunications Facility Inventory

Telecommunications Facility Inventory

FS-2700-10a (03/06)

OMB No. 0596-0082

FACILITY OWNER or FACILITY MANAGER

Name of Communications Site:      

Name of Facility Owner or Manager:      

Do you, as the owner of this communications facility, operate any communications equipment in this facility? yes no (please check one).

If yes, what is your type of use?      .

(Please identify one of the 10 categories described in the Forest Service Handbook 2709.11, section 36.2 (Interim Directive).

PLEASE LIST ALL OCCUPANTS THAT WERE IN YOUR FACILITY ON SEPTEMBER 30TH OF THIS YEAR. INDICATE THEIR TYPE OF USE AND SPECIFY WHETHER THEY ARE A "TENANT" OR "CUSTOMER." (SEE BELOW). INCLUDE OCCUPANTS IN YOUR FACILITY THAT MAY HAVE A CONTRACTUAL AGREEMENT WITH SOMEONE OTHER THAN YOU.

CUSTOMER(1) or

OCCUPANT (Commercial Name) TYPE OF USE TENANT(2)

     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     

(1) A "customers" is an individual, business, organization, or agency that is paying a facility owner or manager, or tenant for communications services and is not reselling communications services to others. Private ("other" use category) and internal (private mobile radio services category) communications uses leasing space in a facility and not re-selling communications services to others are considered customers.

(2) A "tenants" is a communications user who rents space in a communications facility and operates communications equipment for the purpose of re-selling communications services to others, such as CMRS providers, or users in the communications business, such as TV and radio broadcasters.

I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE INFORMATION PROVIDED ABOVE IS TRUE, CORRECT, AND COMPLETE.

Signature: Date:       (mm/dd/yyyy)

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0082. The time required to complete this information collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 975-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

The Privacy Act of 1974 (5 U.S.C. 552a) and the Freedom of Information Act (5 U.S.C. 552) govern the confidentiality to be provided for information received by the Forest Service.