Form FCC Form 321 FCC Form 321 Aeronatutical Frequency Notification

FEDERAL COMMUNICATIONS COMMISSION WASHINGTON, DC 20554 AERONAUTICAL FREQUENCY NOTIFICATION FCC Form 321

1. If this is a non-cable MVPD system, does the system serve more than 1000 subscribers or more than 1000 units?  YES  NO

2. Indicate the name, mailing address, and telephone number of the MVPD.

Legal Name		FCC Registration No. (FRN)
Assumed/ doing business as name (dba)
Mailing Address	City		State	Zip Code
Telephone No. ( )	Email (optional)

3. Indicate on Exhibit 1 the names of the communities affected and their respective FCC Identifiers.

4. Indicate the name, telephone number, and e-mail address (if any) of the local system official who is responsible for compliance with the rules.

Official’s Name

Telephone No. ( )

E-mail Address (optional)

5. Indicate the geographical coordinates in NAD83 of the central point of the system and a radius that encompasses the entire cable plant.

Latitude       o      ’       ” N S

Longitude       o      ’      ” E W

Radius (in kilometers)      

6. Indicate on Exhibit 2 all frequencies carried at an average power level equal to or greater than 38.75dBmV (i.e. 10^-4 Watts) across a 25 kHz bandwidth in any 160 microsecond period including tolerance, and modulation. Indicate here the maximum of those average power levels:

Maximum Power Level (dBmV)

6. Certification

By signing below, the operator certifies that:

1. The system monitoring procedures comply with the requirements of 47 C.F.R. § 76.614 and § 76.1706.

2. Neither the operator nor any other “party” to the notification is subject to a denial of federal benefits that includes FCC benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. § 862. For the definition of a “party” for this purpose refer to 47 C.F.R. § 1.2002(b).

Type or Print Name      	Title      
Signature      	Date      

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (18 U.S.C. § 1001) AND/OR REVOCATION OF ANY STATION LICENSE (47 U.S.C. § 312 (a) (1)), AND/OR FORFEITURE (47 U.S.C. § 503(b)).

EXHIBIT 1

FCC Identifier	Community Name and State
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     

Use additional pages as needed

EXHIBIT 2

Frequency (MHz)	Frequency Tolerance	Modulation
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     

Use additional pages as needed

INSTRUCTIONS FOR FCC FORM 321

AERONAUTICAL FREQUENCY NOTIFICATION

MVPDs planning to use the frequencies in the aeronautical radio communications or navigational frequency bands must notify the Commission prior to the activation of these frequencies. The aeronautical operational requirements in the aeronautical bands are contained in 47 C.F.R § 76.1804. Each notification shall include an FCC Form 159 (Fee Filing Form), accompanied by the appropriate fee (see Media Bureau Fee Filing Guide to obtain fee information).

1. If this is a non-cable MVPD system, indicate whether the system serves more than 1000 subscribers.

2. Provide the legal name, FCC registration number (FRN), any assumed name for doing business as (dba) in the community, complete mailing address including zip code, and telephone number in the spaces provided.

3. Provide a list of all the Community Unit Identifiers (CUIDs), community names, and states contained within the radius of this Aeronautical Frequency Notification on Exhibit 1. Non-cable MVPDs must provide their Non-Cable Identifier (NCID). If the non-cable MVPD does not have an NCID one will be supplied when this form is accepted. Non-cable MVPDs should provide as a community name the name by which their service area is generally known such as the subdivision, development, building, building complex, campus, neighborhood, etc. Additional pages may be attached if necessary.

4. In the spaces provided, indicate the contact name, telephone number, and e-mail address, if any, for the local system official responsible for compliance with the rules.

5. In the spaces provided, indicate the latitude and longitude using NAD 83 datum in degrees, minutes and seconds, to the nearest one tenth of a second, of the point nearest the center of the system. Provide the radius of the system in kilometers (1 mile = 1.61 km) from the center point to the most remote point of the plant (existing or planned). Non-cable MVPDs should give the smallest radius that defines a boundary that fully encloses all of their system (as small as 0.1 km).

6. In the space provided indicate the maximum power of those measured across all 25 kHz bandwidth in any 160 µsec. period in the aeronautical bands. On Exhibit 2, list all frequencies carried at an average power level equal to or greater than 38.75dBmV (i.e. 10^-4 Watts) across a 25 kHz bandwidth in any 160 µsec. period including tolerance, and modulation Additional pages may be attached if necessary.

7. The person responsible for this form must provide their name, title, signature, and the date in the space provided.

Send completed Form 321 along with Fee Form 159 to:

Federal Communications Commission

Media Bureau

P.O. Box 358205

Pittsburgh, PA 15251-5205

FCC NOTICE TO INDIVIDUALS REQUIRED BY THE PRIVACY ACT AND THE PAPERWORK REDUCTION ACT

The FCC is authorized under the Communications Act of 1934, as amended, to collect the personal information we request in this form. We will use the information provided in the application to determine whether approving this application is in the public interest. If we believe there may be a violation or potential violation of a FCC statute, regulation, rule or order, your application may be referred to the Federal, state or local agency responsible for investigating, prosecuting, enforcing or implementing the statute, rule, regulation or order. In certain cases, the information in your application may be disclosed to the Department of Justice or a court or adjudicative body when (a) the FCC; (b) any employee of the FCC; or (c) the United States Government is a party to a proceeding before the body or has an interest in the proceeding. In addition, all information provided in this form will be available for public inspection.

If you owe a past due debt to the federal government, any information you provide may also be disclosed to the Department of Treasury Financial Management Service, other federal agencies and/or your employer to offset your salary, IRS tax refund or other payments to collect that debt. The FCC may also provide this information to these agencies through the matching of computer records when authorized.

If you do not provide the information requested on this form, the application may be returned without action having been taken upon it or its processing may be delayed while a request is made to provide the missing information. Your response is required to obtain the requested authorization.

We have estimated that each response to this collection of information will take 40 minutes, on average. Our estimate includes the time to read the instructions, look through existing records, gather and maintain the required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-0331), Washington, DC 20554. We will also accept your comments via the Internet if your send them to [email protected]. Please DO NOT SEND COMPLETED APPLICATIONS 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 of if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0331.

THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, P.L. 93-579, DECEMBER 31, 1974, 5 U.S.C. 552a(e)(3), AND THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, OCTOBER 1, 1995, 44 U.S.C. 3507.

FCC 321

Approved by OMB

3060-0331