post card (current)

SSA Boldly Go TV BRC - total.pdf

Public Information Campaign

post card (current)

OMB: 0960-0544

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Dear Public Service Director:
Please take a moment to complete the following information. It will help us determine the
kind of PSAs you want to receive in the future and ensure we will send you the correct
format. Thank you for your cooperation and support.
Can you accept digital files?  Yes  No
If yes, what file formats are best for you?
Would you like the digital files sent to you or do you prefer downloading them from a site:
	
 Sent to me  Downloading  Both
Can you accept digital collateral materials?  Yes  No
If yes, what file formats are best for you?
	
Title:		
# Times Per Week Aired	 # Weeks Aired
	

“It’s so easy, even Kirk could do it.”	 :30	
“C’mon George, kick the tires!”	
:30	
“Boldly go to socialsecurity.gov!”	
:30	
“No Check, Go Direct.”	
:30	
“Pointy Ears.”	
:10	
“Eminently logical.”	
:10	
“It makes the crankiest Klingon smile.”	 :10	
“Chekov applied in his pajamas.”	
:15	

1-3
1-3
1-3
1-3
1-3
1-3
1-3
1-3

4-6
4-6
4-6
4-6
4-6
4-6
4-6
4-6

7-9
7-9
7-9
7-9
7-9
7-9
7-9
7-9

10-12
10-12
10-12
10-12
10-12
10-12
10-12
10-12

16+	
16+	
16+	
16+	
16+	
16+	
16+	
16+	

Name:
Call Letters:
Telephone:	

Fax:	

Address:	
City:

State:

Zip:

1-3
1-3
1-3
1-3
1-3
1-3
1-3
1-3

4-6
4-6
4-6
4-6
4-6
4-6
4-6
4-6

7-9
7-9
7-9
7-9
7-9
7-9
7-9
7-9

10-12
10-12
10-12
10-12
10-12
10-12
10-12
10-12

16+
16+
16+
16+
16+
16+
16+
16+

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