Draft
Not Yet Approved by OMB
OMB Control Number 3060-1308
November 2023
Estimated Time per Response – 6 hours
One-Time Information Collection for
International Section 214 Authorization Holders
WARNING : You are accessing a U.S. Government information system provided by the Federal Communications Commission for FCC-authorized users only. All communications occurring on this information system are subject to being monitored, recorded, and audited; therefore, you have no reasonable expectation of privacy regarding any communications or data transmitted or stored in this information system. Unauthorized or improper use of the information system or information stored in this information system is prohibited and subject to criminal, civil, and/or administrative penalties. Any data transmitted or stored in this information system may be disclosed to law enforcement or other Federal agencies or their contractors in the course of conducting an investigation or other forensic analysis. USE OF THIS INFORMATION SYSTEM INDICATES CONSENT TO MONITORING AND RECORDING.
Continue (Select)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Important Technical Notices – We ask all Authorization Holders to review the form’s technical limitations before answering the questions below.
The Filer is Unable to Go Back to Previously Answered Questions. The filer cannot go back and review earlier responses after moving to the next question.
The System Will Provide A Copy of the Filer’s Answers to the Questions Only After the Filer Submits the Completed Form. A PDF document with the Authorization Holder’s answers will be available only after the filer completes and submits the survey.
Carefully Review Answers Before Continuing to the Next Question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the filer to carefully review the answer to each question before moving to the next question.
Copies of Questions and Responses. The Authorization Holder may save a copy of each response before continuing to the next question.
For example, the Authorization Holder may print a copy of each response or take a screen shot of each answer before moving to the next question.
Timing Out After One Hour of Inactivity. The One-Time Information Collection will time out after one hour of inactivity. If this occurs, an email containing a link will be sent to the Authorization Holder that will allow it to complete the One-Time Information Collection.
An email containing the link will be sent to the email address that the Authorization Holder used to log into the online system.
If the email address of the Authorization Holder’s Certifying Official was entered in response to Question 3.b. beforehand, an email containing the link will also be sent to the Certifying Official’s email address.
Do Not Use the Back Button on the Browser. If the Authorization Holder clicks on the “Back” button of the browser or directly opens an embedded link, the Authorization Holder will be directed out of the form, and automatically will time out of the system after one hour of inactivity. The Authorization Holder will need to either:
Use the link that will be provided in an email to complete the One-Time Information Collection (see “Timing Out After One Hour of Inactivity”), or
Use the link provided on the One-Time Information Collection webpage to log into the system and respond to each question again starting at the beginning of the form.
How to Open Embedded Links. To open embedded links in any part of the form, “right click” on a link and select “Open Link in New Tab.” If the Authorization Holder instead directly clicks on and opens an embedded link, the Authorization Holder will be directed out of the form, and automatically will time out of the system after one hour of inactivity. The Authorization Holder will need to either:
Use the link that will be provided in an email to complete the One-Time Information Collection (see “Timing Out After One Hour of Inactivity”), or
Use the link provided on the One-Time Information Collection webpage to log into the system and respond to each question again starting at the beginning of the form.
Continue (Select)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
In the Evolving Risks Order and Notice of Proposed Rulemaking (FCC 23-28), the Federal Communications Commission (FCC) adopted an order requiring all International Section 214 Authorization Holders (Authorization Holders) to respond to a one-time collection to update the Commission’s records regarding their foreign ownership.
Questions in the One-Time Information Collection [add link]
Instructions [add link]
Frequently Asked Questions (FAQs) [add link]
FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT [add link]
Privacy Act Statement [add link]
Publication of the One-Time Information Collection – All responses, including any personally identifiable information (PII) provided, will be made publicly available in IB Docket No. 23-119 and associated with the Authorization Holder’s International Section 214 Authorization(s) in the International Communications Filing System (ICFS), except to the extent that any material or information is afforded confidential treatment. For more information about the Commission’s uses and disclosures of such information, see https://www.fcc.gov/sites/default/files/sor-fcc-ib-1.pdf.
Failure to Respond – The Commission is currently considering in a Notice of Proposed Rulemaking in IB Docket No. 23-119 whether to cancel the authorizations of carriers that fail to timely respond to the One-Time Information Collection and to impose forfeitures or other measures where a carrier fails to respond in a timely or complete manner. (FCC 23-28)
Willful False Statements – Willful false statements on this form are punishable by fine and/or imprisonment (U.S. Code, Title 18, Section 1001), and/or revocation of any station license or construction permit (U.S. code, Title 47, Section 312(a)(1)), and/or forfeiture (U.S. Code, Title 47, Section 503).
Continue (Select)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.1. Enter the 10-digit FCC Registration Number (FRN) of the Authorization Holder.
Include all leading zeros when entering the FRN.
See instructions for further requirements regarding FRNs. [[add link]]
______________ (Fill-in box)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.1.a. Review the following entity (or registrant) information.
If the Entity Name or Entity Type (or Registrant Name or Registrant Type) is incorrect or blank, the Authorization Holder must log into CORES and update the information before continuing the One-Time Information Collection.
Registration Date (imported from CORES)
Last Updated (imported from CORES)
Entity/Registrant Name (imported from CORES)
Entity/Registrant Type (imported from CORES)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.2. Enter all of the Authorization Holder’s current International Section 214 Authorization File Numbers associated with this FRN.
For any FRN, only report all of the Authorization File Numbers associated with that FRN.
If an Authorization Holder has more than one FRN associated with current International Section 214 Authorization File Numbers, the Authorization Holder will need to identify each FRN and all of the associated current Authorization File Number(s) in separate responses to this One-Time Information Collection.
Leave blank any fields that are not applicable.
Do not use dashes or spaces when entering the Authorization File Numbers.
For example, enter: ITC2142023073100001 or ITCMOD2023073100001
See instructions for further requirements regarding FRNs. [[add link]]
Error Message - Entering an Authorization File Number that is not associated with the Authorization Holder’s FRN will result in an error message and prevent the Authorization Holder from advancing to the next question. If the Authorization Holder receives an error message, the Authorization Holder must use the link provided in the error message and restart the One-Time Information Collection from the beginning of the form.
Additional Assistance - If the Authorization Holder does not know the Authorization File Number(s) associated with its FRN, the Authorization Holder should visit the ICFS homepage at https://fcc.gov/icfs. For questions relating to ICFS, email [email protected] or call ICFS Help Line at (202) 418-2222 (Monday-Friday, 8:30 a.m.-4:30 p.m. ET).
File Number 1 ______________ (Fill-in box)
(49 Fill-in boxes)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.2.a. Does the Authorization Holder have any additional Authorization File Numbers associated with this FRN?
Yes
No
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.2.b. Enter all of the remaining Authorization File Numbers associated with this FRN.
Do not use dashes or spaces when entering the Authorization File Numbers.
Separate the Authorization File Numbers with commas.
Do not add a space after each comma.
For example, enter:
ITC2142023073100001,ITCMOD2023073100001
________________________________________________________________ (Fill-in box)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.3. Enter the Authorization Holder’s Contact Information. The contact person should be an officer of the Authorization Holder who will also certify to the truth and accuracy of the information in the form.
First Name (Fill-in box)
Last Name (Fill-in box)
Company or Organization (Fill-in box)
Position/Title (Fill-in box)
Address Line 1 (Street Address) (Fill-in box)
City (Fill-in box)
U.S. State/Territory (Two Letter Abbreviation or OU for international) (Fill-in box)
International State/Province (if OU was entered above) - Optional (Fill-in box)
Zip Code/Postal Code (Fill-in box)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.3.a. Enter the Authorization Holder’s Contact Information (continued).
Country (Select one from list)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.3.b. Enter the Authorization Holder’s Contact Information (continued).
Phone (no dashes) (Fill-in box)
Phone - Country Code (if outside of the United States) – Optional (Fill-in box)
Email Address (Fill-in box)
Fax - Optional (Fill-in box)
Fax - Country Code (if outside of the United States) - Optional (Fill-in box)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.4. Is the authorization(s) subject to a mitigation agreement (e.g., national security agreement, letter of agreement/assurance) entered into by the Authorization Holder with the Executive Branch agencies?
Yes
No
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.5. Enter all of the File Numbers that contain a copy of the mitigation agreement.
Do not use dashes or spaces when entering the File Number.
For example, enter:
ITC2142023073100001
ITCMOD2023073100001
ITCT/C2023073100001
ITCASG2023073100001
ITCAMD2023073100001
The Authorization Holder may enter up to a maximum of 15 File Numbers in this question. If applicable, the Authorization Holder must enter all additional File Numbers that contain a copy of the mitigation agreement in Question 5.b.
Leave blank any fields that are not applicable.
File Number 1 ______________ (Fill-in box)
(15 Fill-in boxes)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.5.a. Does the Authorization Holder have any additional File Numbers that are subject to the mitigation agreement?
Yes
No
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.5.b. Enter all of the remaining File Numbers that are subject to the mitigation agreement.
Do not use dashes or spaces when entering the File Numbers.
Separate the File Numbers with commas.
Do not add a space after each comma.
For example, enter:
ITC2142023073100001,ITCMOD2023073100001,ITCT/C2023073100001,ITCASG2023073100001,ITCAMD2023073100001
______________________________________________________ (Fill-in box)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.6. Does the Authorization Holder qualify for the Exemption from completing the latter portion (Questions 9-14) of this form? To meet the Exemption:
The Authorization Holder must have filed an application for an initial International Section 214 Authorization, modification, or substantial (not a pro forma filing) assignment or transfer of control of the authorization that was reviewed by the Executive Branch agencies and was granted by the Commission on or after XXXX xx, 2020 [[add date 3 years before the date of the filing deadline]]; and
There are no reportable Foreign Interest Holders of the Authorization Holder other than those disclosed in the application (including any amendment), and there are no changes to the reportable Foreign Interest Holders disclosed in the application (including any amendment) as of XXXX xx, 2023 [[add date thirty (30) days prior to the date of the filing deadline for this One-Time Information Collection]].
Yes
No
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.7. Identify the File Number of the application that fulfills all of the requirements for the Exemption. If more than one application fulfills all of these requirements, provide the most recent File Number.
Do not use dashes or spaces when entering the File Number.
For example, enter: ITC2142023073100001, ITCMOD2023073100001, ITCT/C2023073100001, or ITCASG2023073100001
__________________ (Fill-in box)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.8.
Aggregate and identify all of the citizenship(s) or place(s) of organization for every foreign individual and/or entity (including a government organization) that directly and/or indirectly holds 10% or greater equity and/or voting interests, or a controlling interest, in the Authorization Holder (Reportable Foreign Ownership).
Each Authorization Holder is required to identify Reportable Foreign Ownership where any interest holder (including a government organization) has a place of organization in or is a citizen of a country that meets the Department of Commerce’s definition of a “foreign adversary.” (FCC 23-28)
A “foreign adversary” is defined in the Department of Commerce’s rule, 15 CFR § 7.4. These are: (1) The People’s Republic of China, including the Hong Kong Special Administrative Region (China), (2) Republic of Cuba (Cuba), (3) Islamic Republic of Iran (Iran), (4) Democratic People’s Republic of Korea (North Korea), (5) Russian Federation (Russia), and (6) Venezuelan politician Nicolás Maduro (Maduro Regime).
To identify Reportable Foreign Ownership that meets the Department of Commerce’s definition of “Venezuelan politician Nicolás Maduro (Maduro Regime),” an Authorization Holder can select “Maduro Regime” as a separate, additional response to “Country of Citizenship or Place of Organization.”
An Authorization Holder must also identify Reportable Foreign Ownership from non-“foreign adversary” countries.
Countries of Citizenship or Places of Organization (Select potentially multiple from list)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.9. Does the Authorization Holder have any 10% or greater direct or indirect Foreign Interest Holders that hold such equity and/or voting interests or any controlling interest (Reportable Foreign Ownership) as of [[x]] (i.e., thirty (30) days prior to the filing deadline for this One-Time Information Collection)?
Yes
No
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.9.a. Select the number of Foreign Interest Holders that directly and/or indirectly hold 10% or greater equity and/or voting interests, or a controlling interest, in the Authorization Holder. Questions 10 and 11 will repeat for the number of Foreign Interest Holders that are specified in this question.
__________________ (Select one from list)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Foreign Interest Holder [[x]] of [[x]]
Q.10. Identify each foreign individual and/or entity (including a government organization) that directly and/or indirectly holds 10% or greater equity and/or voting interests, or a controlling interest, in the Authorization Holder (Reportable Foreign Ownership) as of [[x]] (i.e., thirty (30) days prior to the filing deadline).
Each Authorization Holder is required to identify Reportable Foreign Ownership where any interest holder (including a government organization) has a place of organization in or is a citizen of a country that meets the Department of Commerce’s definition of a “foreign adversary.” (FCC 23-28)
A “foreign adversary” is defined in the Department of Commerce’s rule, 15 CFR § 7.4. These are: (1) The People’s Republic of China, including the Hong Kong Special Administrative Region (China), (2) Republic of Cuba (Cuba), (3) Islamic Republic of Iran (Iran), (4) Democratic People’s Republic of Korea (North Korea), (5) Russian Federation (Russia), and (6) Venezuelan politician Nicolás Maduro (Maduro Regime).
To identify Reportable Foreign Ownership that meets the Department of Commerce’s definition of “Venezuelan politician Nicolás Maduro (Maduro Regime),” an Authorization Holder can select “Maduro Regime” as a separate, additional response to “Country of Citizenship or Place of Organization.”
An Authorization Holder must also identify Reportable Foreign Ownership from non-“foreign adversary” countries.
If the Authorization Holder has one or more foreign individual(s) and/or entity(ies) (including a government organization) that directly and/or indirectly holds a Reportable Foreign Ownership interest, the Authorization Holder must complete the following questions (Questions 10-11) for each reportable Foreign Interest Holder (up to 41).
If the Authorization Holder has more than 41 reportable Foreign Interest Holders, the Authorization Holder must provide the information about all of its remaining Foreign Interest Holders in a follow-up question (Question 13).
Legal Name of Foreign Interest Holder (Fill-in box)
Percentage of Equity Interests Held (to the nearest one percent) (Fill-in box)
Percentage of Voting Interests Held (to the nearest one percent) (Fill-in box)
Description of Controlling Interests (if applicable, or enter “None”) (Fill-in box)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Foreign Interest Holder [[x]] of [[x]]
Q.11. Identify all of the Countries of Citizenship or Places of Organization of the Foreign Interest Holder, including the United States.
Countries of Citizenship or Places of Organization (Select potentially multiple from list)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.12. The Authorization Holder has indicated it has 42 or more Foreign Interest Holders that directly and/or indirectly hold 10% or greater equity and/or voting interests, or a controlling interest, in the Authorization Holder. The Authorization Holder must provide the information about all of its remaining Foreign Interest Holders in response to Question 13.
Continue
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.13. Identify all of the remaining foreign individual(s) and/or entity(ies) (including a government organization) that directly and/or indirectly hold 10% or greater equity and/or voting interests, or a controlling interest, in the Authorization Holder (Reportable Foreign Ownership) as of [[x]] (i.e., thirty (30) days prior to the filing deadline), beyond the 41 Foreign Interest Holders identified by the Authorization Holder in its response to the same questions concerning reportable Foreign Interest Holders (Questions 10-11).
Provide this information by:
Responding to all of the questions in the .csv attachment available at the enclosed link ([add link]), with respect to each of the remaining reportable Foreign Interest Holders, and
Uploading the completed .csv attachment.
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.14. The Authorization Holder certifies that it does not have 10% or greater direct or indirect Foreign Interest Holders that hold such equity and/or voting interests or any controlling interest (Reportable Foreign Ownership) in the Authorization Holder as of [[x]] (i.e., thirty (30) days prior to the filing deadline).
I Certify
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.15. I certify under penalty of perjury that:
I am an officer of the Authorization Holder and
All of the information submitted in this form is true and accurate.
I Certify
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
Q.16. Type the Certifying Official’s full name in the box below. (Fill-in box)
For purposes of this filing, the entry of the Certifying Official’s name on this line shall constitute that individual’s electronic signature to this certification. Persons making willful false statements in this form can be punished by fine or imprisonment under the Communications Act. 47 U.S.C. § 220(e).
Signature (Fill-in box)
Date - MM/DD/YYYY (Automatically generated)
IMPORTANT NOTE: Keyboard-only users must use the tab button until the desired answer is highlighted, then use the space bar to select the desired answer, then use the tab button until the forward button is highlighted, and finally use the enter key to continue to the next page.
IMPORTANT TECHNICAL LIMITATION OF THE FORM: The Authorization Holder cannot go back and review its earlier responses after it moves to the next question. Because an officer of the Authorization Holder must certify to the truth and accuracy of its responses at the end of the form, we encourage the Authorization Holder to carefully review its answer to each question before moving to the next question. It may be helpful for the Authorization Holder to save a copy of each response before continuing to the next question. For example, you may print a copy of each answer, save each answer as a PDF, or take a screen shot of each answer before moving to the next question.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 2023-12-12 |