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 - Eligible Entity Seeking Reimbursement - TV Broadcaster Relocation Fund (Business for Profit) Form and Instruction	Modified
3060-1223 revised for FY19 version_030119.docx Supporting Statement A	2019-03-01

IC Document Collections

IC ID	Document Title	Status
224901	Payment Instructions - Eligible Entity Seeking Reimbursement - TV Broadcaster Relocation Fund - State, Local & Tribal Govt	Modified
224900	Payment Instructions - Eligible Entity Seeking Reimbursement - TV Broadcaster Relocation Fund (Business for Profit) Form and Instruction	Modified

ICR Details

OMB Control No: 3060-1223	ICR Reference No: 201901-3060-007
Status: Active	Previous ICR Reference No: 201706-3060-021
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: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/23/2019
	Date Received in OIRA: 03/06/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2022	36 Months From Approved	09/30/2020
Responses	2,500	0	2,000
Time Burden (Hours)	12,500	0	6,000
Cost Burden (Dollars)	0	0	0

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Abstract: The Spectrum Act requires the Commission to reimburse eligible entities for costs “reasonably incurred” to stations relocating to new channels as a result of the repacking process or a winning reverse auction bid.The RAY BAUMS Act of 2018 added the new categories of eligible entities that we are now adding to the form. This information collection is a standardized form for eligible entities to submit additional information to facilitate incentive payments.

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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. 115 - 141 1452 Name of Law: Repack Airwaves Yielding Better Access for Users of Modern Services Act of 2018, Div. P (RAYBAUM's)

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 66261	12/26/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 8096	03/06/2019
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 - Eligible Entity Seeking Reimbursement - TV Broadcaster Relocation Fund (Business for Profit)	FCC Form 1876	Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund
Payment Instructions - Eligible Entity Seeking Reimbursement - TV Broadcaster Relocation Fund - State, Local & Tribal Govt

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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	2,500	2,000	0	500	0	0
Annual Time Burden (Hours)	12,500	6,000	0	6,500	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: The Commission is reporting program changes/increases to this revised collection. There are increases to the total number of respondents of +2,500, total annual responses of +2,500 and total annual burden hour of +12,500 hours as a result of allowing additional types of entities—TV translator stations, low power TV stations, and FM radio stations to this collection. There are no adjustments to this collection.

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Annual Cost to Federal Government: $171,150

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 03/06/2019

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