FCC Form 5653 Request for Rapid Broadband Assessment Team (RBAT) Revie

FCC-5653
Estimated time per
response: 2 hours

Federal Communications Commission
Washington, D.C. 20554

OMB No.: 3060-1151
Edition Date: [[month 2024]]
Pending OMB Approval

REQUEST FOR RBAT REVIEW AND ASSESSMENT
Thank you for submitting a request for RBAT (Rapid Broadband Assessment Team) review and
assessment pursuant to 47 CFR § 1.1415. The RBAT is an intra-agency team with expertise in
the pole attachment rules and orders of the Federal Communications Commission (FCC),
adopted pursuant to 47 U.S.C. § 224. The RBAT consists of staff from the FCC’s Enforcement
Bureau and Wireline Competition Bureau. This form gathers important information about a
party’s request for review of a pole attachment dispute that the party alleges is impeding or
delaying an active broadband deployment plan or project. Your submission will assist the RBAT
in efficiently reviewing and assessing the parties’ dispute.
Please submit your completed form via e-mail to [email protected]. Prior to
submitting this form, you must notify the Chief of the Enforcement Bureau’s Market Disputes
Resolution Division (MDRD) by phone and in writing of your intention to request RBAT
review. By submitting this form, you confirm that you have previously notified the MDRD
Chief of your intention to request RBAT review and that the information provided herein is
accurate and complete to the best of your knowledge. If you have any questions or need further
assistance, please contact the Enforcement Bureau’s Market Disputes Resolution Division staff
at (202) 418-7330 or [email protected].
Section 1.

Information Identifying the Submitting Party

Please provide your contact information and the contact information of any legal counsel
representing you in this dispute.
•

Name of Provider or Company Submitting this Request

•

Type of Provider (examples include cable television system, provider of
telecommunications service, other (if “other,” please explain))

•

Contact Person Information. Please provide the contact person’s name, title, email
address, phone number, and mailing address.

•

Attorney Information. If a law firm or other outside counsel is currently representing
you in this dispute, please provide the law firm name, attorney name, email address,
phone number, and mailing address.

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FCC-5653
Estimated time per
response: 2 hours

Section 2.

Federal Communications Commission
Washington, D.C. 20554

OMB No.: 3060-1151
Edition Date: [[month 2024]]
Pending OMB Approval

Information Identifying the Other Party or Parties to the Dispute

Please provide contact information for the other party or, if applicable, the other parties to
this dispute. If there is more than one other party, please provide that information in the
Additional Comments section at the end of this form.
•

Name of Provider or Company

•

Type of Provider or Company

•

Contact Person Information of Other Party or Parties. Please provide the contact
person’s name, title, email address, phone number, and mailing address.

•

Attorney Information. If a law firm or other outside counsel is currently representing
the other party or parties in this dispute, please provide the law firm name, attorney
name, email address, phone number, and mailing address.

Section 3.

Relevant Statutory Provisions, Rules, and/or Orders

Please identify the relevant statutory provision(s) and section(s) of the FCC rules or orders
alleged to have been violated.
•

Alleged Statutory Provision(s) Violated

•

Alleged Rule Section(s) Violated

•

Alleged FCC Order(s) Violated

•

Summary of Alleged Violation(s). Please describe any potential harm that is occurring
or is likely to occur as a result of the situation and any aspects of the dispute requiring
immediate redress.
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FCC-5653
Estimated time per
response: 2 hours

Section 4.

Federal Communications Commission
Washington, D.C. 20554

OMB No.: 3060-1151
Edition Date: [[month 2024]]
Pending OMB Approval

The Dispute

Please provide the following information to the extent known.
•

Does the dispute relate to an active broadband facilities deployment plan or project? If
yes, briefly explain.

•

Is the plan/project subject to a government-funded broadband program deadline?

•

Is the locus of the dispute in an unserved or underserved area?

•

Summarize the specific relief sought.

•

Does a pole attachment agreement govern the parties’ relationship?

•

Have the parties entered into a nondisclosure agreement?

•

Summarize any steps already taken in an attempt to resolve the matter with the other
party or parties to the dispute.

•

Are you amenable to FCC staff-supervised mediation of your dispute?

•

Have you spoken with the other party or parties to the dispute regarding the use of
FCC staff-supervised mediation?

•

If yes, are the other party(ies) amenable to mediation?
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FCC-5653
Estimated time per
response: 2 hours

Section 5.

Federal Communications Commission
Washington, D.C. 20554

OMB No.: 3060-1151
Edition Date: [[month 2024]]
Pending OMB Approval

Suitability for Placement on the Accelerated Docket

To assist the RBAT in determining whether the dispute or a portion of the dispute is
suitable for placement on the FCC’s Accelerated Docket under 47 CFR § 1.736, please
provide the following information (if available).
•

Do you intend to seek inclusion of the matter on the FCC’s Accelerated Docket under
47 CFR § 1.736?

•

If you intend to seek inclusion of the matter on the FCC’s Accelerated Docket under 47
CFR § 1.736, provide a proposal below as to how best to resolve the matter within the
60-day deadline.

•

List the number of poles subject to this dispute.

•

List the number of attachment applications that are currently pending with the other
Party or Parties to this dispute.

•

Will discovery be required in order to resolve this dispute? If yes, describe the areas of
discovery that might be required.

•

Will expert testimony be required to resolve this dispute?

I verify that I am submitting this form and that the information provided is accurate and
complete to the best of my knowledge.
Name/Date:

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FCC-5653
Estimated time per
response: 2 hours

Federal Communications Commission
Washington, D.C. 20554

OMB No.: 3060-1151
Edition Date: [[month 2024]]
Pending OMB Approval

Additional Comments
Please provide in the space below any additional information that you believe will assist the
RBAT in resolving this dispute.

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FCC-5653
Estimated time per
response: 2 hours

Federal Communications Commission
Washington, D.C. 20554

OMB No.: 3060-1151
Edition Date: [[month 2024]]
Pending OMB Approval

PRA Burden Statement
We have estimated that your response to this collection of information will take an average
of 2 hours. Our estimate includes the time to read the instructions, look through existing
records, gather and maintain 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, Office of Managing Director, AMD-PPM, 45 L Street, NE, Washington, DC
20554, Paperwork Reduction Act Program (3060-1151). We will also accept your PRA
comments via the Internet if you send an e-mail to [email protected].
Please DO NOT SEND COMPLETED [SURVEYS, APPLICATION FORMS, ETC] TO
THIS ADDRESS. 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 and/or we fail to provide you with
this notice. This collection has been assigned an OMB control number of 3060-1151.
THIS NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995,
PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

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