Form FCC Form 2100, Sch FCC Form 2100, Sch Pre-Auction Technical Certification Form

INSTRUCTIONS FOR FORM 2100, SCHEDULE 381

Pre-Auction Technical Certification Form

Not Yet Approved By OMB

General Instructions

This form must be completed by full power and Class A television licensees with a facility eligible for relinquishment in the broadcast television incentive auction and protection in the repacking process (“Eligible Facility”), as listed in a Public Notice released by the Media Bureau (“Eligibility PN”). See Expanding the Economic and Innovative Opportunities of Spectrum Through Incentive Auctions, GN No. 12-268, Report and Order, 29 FCC Rcd 6567, 6651, n. 615 (2014)(“Incentive Auction Report and Order”).

Eligible Facilities include facilities entitled to mandatory protection (i.e., facilities that were licensed or were the subject of a pending license to cover application as of February 22, 2012), as well as those to which the Commission has afforded discretionary protection.  Incentive Auction Report and Order, 29 FCC Rcd at 6652-67 (describing facilities afforded mandatory or discretionary protection).  Holders of authorizations for either mandatory or discretionary protection facilities must complete this Form and make the required certifications with respect to such facilities.  For purposes of these instructions the term “licensee” refers to all holders of authorizations that have been afforded mandatory or discretionary protection as described in the Eligibility Public Notice.

Completion of this form will enable the Commission to ensure the accuracy of the technical data in its database for these Eligible Facilities and facilitate the incentive auction repacking process. Id. at 6651, n. 615. Licensees must certify that all information provided on this Form is correct to the best of the licensee’s knowledge.

Item 1: Database Certification

The licensee must certify that it has reviewed the authorization for its Eligible Facility as well as the “database technical information” related to the authorization and confirm that all information is correct with respect to actual operations. “Database technical information” includes all underlying technical data that sets forth the operational parameters of the Eligible Facility, including but not limited to technical information that may be found in the Commission’s Consolidated Database System and Antenna Registration System (“Database Technical Information”). This Form will prefill with the authorization file number for the Eligible Facility about which the licensee must make its certification.

In making its certification the licensee must either indicate that:

1. the authorization for the Eligible Facility and all underlying Database Technical Information is knowledge;

2. the authorization for the Eligible Facility is inaccurate because of a discrepancy between the authorization and the underlying Database Technical Information on file with the Commission (in which case it must supply an explanatory exhibit); or

3. it is operating the Eligible Facility with parameters at variance from those specified in its authorization and the database technical information. In this case, the licensee must file an application for modification of its facility (FCC Form 2100, Schedule A) to correct the discrepancy and a request for special temporary authority to operate with parameters at variance pursuant to Section 73.1635 of the Commission’s Rules, 47 C.F.R. § 73.1635. If such application(s) have already been filed, the licensee must supply the file number for the application(s). Note that modifications to the Eligible Facility made to correct unauthorized operations will not be considered in determining the scope of the Eligible Facility’s spectrum usage rights eligible for relinquishment in the broadcast television incentive auction and for protection in the repacking process. The Eligible Facility considered for these purposes will be based on the parameters in the Eligibility PN.

Item 2: Information on Eligible Facility

The licensee must provide details concerning the Eligible Facility. Because distributed transmission system (DTS) facilities are comprised of multiple antenna locations, licensees of DTS facilities will need to complete this item for each facility that is part of their license authorization.

1. Transmitter. The licensee must provide information concerning the Eligible Facility’s primary transmitter, including the make and model of the transmitter (exclude all dashes and spaces); the maximum power output capacity of the transmitter according to the manufacturer’s specifications; and transmitter type (tube or solid state). Licensee should provide this information for the main transmitter used in operation of the Eligible Facility.

2. Antenna. The licensee must provide information concerning the Eligible Facility’s primary antenna including:

1. Indicating the type of antenna from the list provided (or, if the type is not listed, selecting “other” and providing an explanatory exhibit;

2. Indicating whether its primary antenna is capable of operating on multiple channels (e.g., broadband) and, if so, identifying the frequency range (in megahertz);

3. Indicating whether it shares its antenna with another broadcaster(s) and, if so, with whom by listing the facility identification number(s) and call-sign(s) (only valid Facility ID Numbers and Call-Signs will be accepted by the system); and

4. Specifying, by choosing all that apply, where the antenna is located on the antenna support structure (or, if none of the options or additional options apply, selecting “other” and providing an explanatory exhibit).

3. Transmission Line. The licensee must provide information concerning the Eligible Facility’s principal transmission line, which is the line that links the main transmitter to the primary antenna. For purposes of this question the principal transmission line is defined as the part of the transmission line that consists of 90% or more of the entire transmission system. It must identify the type of transmission line and, if “rigid,” must select one of the lengths from the options provided. If no single component consists of 90% or more of the entire transmission system, include an explanatory exhibit.

4. Antenna Support Structure. For the antenna support structure (e.g., the tower, building, etc.) on which the Eligible Facility’s primary antenna is located, the licensee must indicate:

1. The year in which a structural analysis was last conducted (or, if no structural analysis has been conducted the licensee must select “other” and provide an exhibit explaining why no analysis has been conducted);

2. Under which version of the ANSI/TIA-222 standard “Structural Standards for Antenna Supporting Structures and Antennas” was the last analysis conducted (or. if none of the options apply, the licensee must select “other” and provide an exhibit in which it indicates under which structural analysis, if any, the structure was last analyzed; and

3. Whether the antenna support structure on which its primary antenna is located is owned by the licensee, including any entity under common ownership as the licensee (e.g., a subsidiary or parent company) or leased from a third-party. If the latter, it must provide the name of the lessor.

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT

We have estimated that it will take respondents on average 2 hours to complete this collection of information. 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-xxxx), Washington, DC 20554. We also will also accept your PRA comments via email please 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 or sponsor 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-xxxx.

THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, OCTOBER 1, 1995, 44 U.S.C. § 3507.

SCHEDULE 381

1. Database Certification (select only one)

Licensee hereby certifies that it has reviewed its license authorization/construction permit and underlying Database Technical Information for its Eligible Facility as reflected in File No. __________________ and

1. it is accurate and complete to the best of its knowledge.

2. it is not accurate because of a discrepancy between the license authorization and underlying Database Technical Information.

If (b) is selected, licensee must explain in the exhibit the discrepancies.

3. it is not accurate because the licensee is operating the Eligible Facility with parameters at variance from those specified in the authorization and the Database Technical Information.

If (c) is selected, the licensee must file an application for modification of its facility (FCC Form 2100, Schedule A) to correct the discrepancy and a request for special temporary authority to operate with parameters at variance. If such application(s) has already been filed, the licensee must supply the file number for the application(s): File No(s).____________________

Exhibit No.

2. Information on Eligible Facility

For the Eligible Facility indicated in Item 1:

1. Transmitter. Provide the following information about the main transmitter(s) used by the Eligible Facility for its primary facility:

1. Make

2. Model

3. Maximum Power output capacity (in kilowatts)

4. Transmitter type (select one)

___ [Tube] ____ [Solid State]

2. Antenna. Provide the following information about the Eligible Facility’s primary antenna:

1. Antenna Type (select one)

[Slot] ____ [Panel] ____ [Traveling wave] ___ [Spiral] ____ [Batwing] ____[Other]

[If selected “Other” and explain in exhibit]

2. Is the primary antenna capable of operating over multiple channels (e.g., broadband)? ___ [Yes] ____ [No]

If yes, select the antenna’s frequency range (in megahertz): From____ To ____

3. Is the primary antenna shared with another television station? ____ [Yes] ____ [No]

If yes, with which station? _______________ [Facility ID Number] _________________ [Call Sign]________

4. Antenna Location (Select all that apply):

___ [Side Mount] ____ [Top Mount] ____ [Candelabra] ____[Stacked-Top] ___[Stacked -Bottom] ____[Other]

[If “Other” is selected, explain in exhibit]

Exhibit No.

3. Transmission Line. Provide the following information for the Eligible Facility’s principal transmission line used to connect its main transmitter to its primary antenna:

1. Type of transmission line (select one): ____[Flexible] ____[Rigid]

If rigid, what length sections ____[20 feet] ____[19.75 feet] ____[19.50 feet] ____[Broadband/Varied Length]

[If no single component consists of 90% or more of the entire transmission system, include an explanatory Exhibit.]

Exhibit No.

4. Antenna Support Structure. Provide the following information related to the antenna support structure for the Eligible Facility’s primary antenna

1. In what year was the last structural analysis conducted on the structure? (select one)

____ [Select Year] ____ [Other]

[If “Other” is selected, explain in exhibit]

Exhibit No.

2. Under what structural standard was the last structural analysis conducted? (select one)

___ [TIA 222-Revision F] __ [TIA 222-Revision G] __ [Other]

[If “Other” is selected, explain in exhibit]

Exhibit No.

3. Does the licensee own this antenna support structure? (select one) ____ [Yes] ____ [No]

If no, provide the name of the third-party entity that owns the antenna support structure: ______________