Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund.

Forms and Documents

Document Name	Status
Form FCC Form 1876 Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund Form	New
Emergency Letter Reimbursement from TV Broadcaster Relocation Fund.pdf Supplementary Document	2016-12-22
Relocation Reimbursement supporting statement (122016).docx Supporting Statement A	2016-12-22

IC Document Collections

IC ID	Document Title	Status
224901	Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund	New
224900	Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund Form	New

ICR Details

OMB Control No: 3060-1223	ICR Reference No: 201612-3060-014
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: FCC	Agency Tracking No: OMD/Financial Operations
Title: Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund.
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 01/17/2017
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/17/2017
	Date Received in OIRA: 12/22/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	6 Months From Approved
Responses	2,000	0	0
Time Burden (Hours)	6,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: FCC is conducting a reverse auction to determine the amount of compensation that each broadcast television licensee would accept in return for voluntarily relinquishing some or all of its broadcast television spectrum usage rights in order to make spectrum available for assignment through a system of competitive bidding. This information collection is a standardized form for successful bidders in the reverse auction to submit additional information to facilitate incentive payments.

Emergency Justfication: The Federal Communications Commission (Commission) requests OMB to authorize emergency processing of a submission of a collection of information, in accordance with 5 CFR 1320.13. The collection of information is a new collection entitled “Payment Instructions from the Eligible Entity Seeking Reimbursement from The TV Broadcaster Relocation Fund”. This information collection is necessary to carry out the Incentive Auction program, which is a high priority and time-sensitive program. Therefore, the Commission requests that OMB approve this information collection by January 17, 2017.

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Authorizing Statute(s): PL: Pub.L. 112 - 96 6403(b)(4)(A) Name of Law: Middle Class Act Tax Relief and Job Creation Act of 2012 (Spectrum Act)
  

Citations for New Statutory Requirements: PL: Pub.L. 112 - 96 6403(b)(4)(A) Name of Law: Middle Class Act Tax Relief and Job Creation Act of 2012 (Spectrum Act)

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3060-AJ82	Final or interim final rulemaking	79 FR 48442	08/15/2014

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 93915	12/22/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 93915	12/22/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund	FCC Form 1876	Relocation Reimbursement Form
Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,000	0	0	2,000	0	0
Annual Time Burden (Hours)	6,000	0	0	6,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection which resulted in a program change/increase of 1,000 respondents, 2,000 responses and 6,000 burden hours. These estimates will be added to OMB’s Active Inventory.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/22/2016

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