FCC Form 484 Schools and Libraries Cybersecurity Pilot Program Applic

OMB Control No. 3060-1323 Estimated Time per Response

[Month] 2024 15 hours

Not Yet Approved by OMB

Schools and Libraries Cybersecurity Pilot Program

Schools and Libraries Cybersecurity Pilot Program Application (FCC Form 484)

(Note: This is a representative description of the information to be collected via the online portal and is not intended to be a visual representation of what each applicant or participant will see, the order in which they will see information, or the exact wording or directions used to collect the information. Where possible, information that was pre-filed in the system portal as part of the applicant’s or participant’s profile will be carried forward and pre-populated into the form.)

Item #	Field Description	Category	Purpose/Instructions
1	Applicant/Participant Name	Entity Information	This is the name of the applicant submitting the first part of this form or the participant submitting the second part of this form—school, school district, library (outlet/branch or system) or a consortium of those entities (schools, libraries, or schools and libraries). If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
2	Entity Number	Entity Information	This is the Unique identifier assigned by the Administrator to the entity listed in Applicant/Participant Name. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
3	Application Number	System Generated	Auto-generated by the system: This is an Administrator-assigned unique identifier for the first and second parts of this application.
4	FCC Registration Number	Entity Information	This is the unique FCC identifier for the applicant/participant. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
5	Employer Identification Number (EIN)	Entity information	The EIN is also known as a Federal Tax Identification Number, and is used to identify a business or non-profit entity. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
6	Mailing Address	Entity Information	This is the mailing address for the applicant/participant. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
7	Telephone Number	Entity Information	This is the main telephone number for the applicant/participant which may/may not be the same as the telephone number for the person who should be contacted with questions about this application. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
8	Contact Person’s Name	Entity Information	Provide the name of the person who should be contacted with questions about this application. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
9	Contact Person’s Title or Position	Entity Information	Provide the title or position of the contact person. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
10	Contact Person’s Telephone Number	Entity Information	Telephone Number of the Contact Person. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
11	Contact Person’s Mailing Address	Entity Information	Mailing Address of the Contact Person. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
12	Contact Person’s E-mail Address	Entity Information	E-mail Address of the Contact Person. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
13	Consultant Information	Entity Information	If the applicant/participant uses a consultant to submit its application, the user must provide the name of the consulting company, the consulting company’s registration number, the consulting company’s telephone number, the consulting company’s email address, the name of the consultant(s) representing the applicant/participant, the telephone number of the consultant(s), the email address of the consultant(s), and the physical address of the consultant(s). If this information has already been entered into the user’s profile, it will be pre-populated into this submission.
14	Type of Applicant/Participant	Entity Information	Options are: school, school district, library/library system, or consortium. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
15	Applicant/Participant Attributes	Entity Information	Attributes for a School or School District include: Public, Private, Charter, and Educational Service Agency (ESA). Attributes for a Library System include: Public and Private. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
16	Tribal Affiliation	Entity Information	If the applicant/participant is a Tribal entity, the applicant/participant will provide its Tribal affiliation. If this information has already been entered into the applicant’s or participant’s profile, it will be pre-populated.
17	E-Rate Status	Entity Information	This is to indicate whether the applicant/participant participates in the E-Rate program. The applicant will select either “Yes” or “No”.
18	E-Rate Discount Percentage	Entity Information	This is the E-Rate Category One discount percentage for the applicant/participant. If this information is in the applicant’s or participant’s profile, it will be pre-populated.
19	Urban/Rural Designation	Entity Information	This is the urban/rural designation for the applicant/participant and will be system populated based on the applicant’s or participant’s physical address.
20	Lead Site Name	Entity Information	For consortia applications or applications with more than one site, this is the name of the site that will be the lead for the Schools and Libraries Cybersecurity Pilot Program project.
21	Number and Location of Participating Sites	Entity Information	For consortia applications or applications with more than one site, the applicant/participant will provide information on the number and location of sites that will be participating in the Schools and Libraries Cybersecurity Pilot Program project. If this data is available in the applicant’s or participant’s profile, it will be pre-populated.
22	Executive Summary of Project	Project Information	Applicants will provide a summary of the proposed Pilot project for which Schools and Libraries Cybersecurity Pilot Program funding is being requested, including, but not limited to, information about the cybersecurity issues the applicant faces and the proposed cybersecurity action plan for the applicant and any other sites that included as part of the project.
23	Description of How Project Funding Will be Used	Project Information	Applicants will describe how the proposed Pilot project would use Schools and Libraries Cybersecurity Pilot Program funding to protect the applicant’s broadband network and data, and address cybersecurity concerns, including, but not limited to, a discussion of the types of equipment and services the applicant plans to purchase and how it plans to use the equipment and services to protect its broadband network and data and manage and address its cybersecurity risks.
24	Previous Cybersecurity Experience	Project Information	Applicants will provide information on whether they have previous experience implementing cybersecurity protections or measures (answered on a yes/no basis), how many years of prior experience the applicant has (answered by choosing from a preset menu of time ranges (e.g., 1 to 3 years)), and whether the applicant has experienced a cybersecurity incident within a year of the date of its application (answered on a “yes/no” basis).
25	Current Cybersecurity Posture and Resources	Project Information	Participants will provide information on their current cybersecurity posture and resources, including, but not limited to, how current cybersecurity risks are being managed and addressed and the cybersecurity equipment and services the participant already has in place.
26	History of Cyber Threats and Attacks	Project Information	Participants will provide information on whether they have experienced a cybersecurity threat or attack, including, but not limited to, the timing and length of the threat or attack, a description of the vulnerabilities exploited and the techniques used to access the system, information about the malicious cybersecurity actor(s), if known, the time it took to detect and respond to the threat or attack, the estimated cost of the threat or attack, and whether/how the cybersecurity threat or attack impacted the applicant’s/participant’s operations, network, or data.
27	Implementation of Education Department or CISA Cybersecurity Recommendations	Project Information	Applicants will provide information on whether they have implemented, or begun implementing, any of the U.S. Department of Education (Education Department) or Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency (CISA) recommended cybersecurity protections and which protections it will or has implemented.
28	Participation in Cybersecurity Collaboration and/or Information Sharing Groups	Project Information	Applicants will provide information on whether they are members of, or plan to join, any cybersecurity collaboration and information-sharing groups and the applicable cybersecurity groups they have joined or plan to join.
29	Other Sources of Funding	Project Information	Applicants will provide information on whether they have received, or expect to receive, cybersecurity funding from any other federal, state, local, Tribal, or other program or source, including information about the source of the other funding, what the other funding will be used for, and whether funding from the Schools and Libraries Cybersecurity Pilot Program would be duplicative of the other funding received.
30	Cybersecurity Risks Proposed Pilot Project will Prevent or Address	Project Information	Applicants will provide information on the cybersecurity risks the proposed Schools and Libraries Cybersecurity Pilot Program project will prevent or address.
31	Pilot Project Implementation and Operation	Project Information	Applicants will provide a description of their plan for implementing and operating the proposed Schools and Libraries Cybersecurity Pilot Program project.
32	Goals and Objectives	Project Information	Applicants will provide information on their goals and objectives for the proposed Schools and Libraries Cybersecurity Pilot Program project.
33	Correction of Known Security Flaws and Routine Backups	Project Information	Participants will provide information on whether they plan to correct known security flaws and/or conduct routine backups as part of the proposed Schools and Libraries Cybersecurity Pilot Program project.
34	Recommended Cybersecurity Best Practices	Project Information	Applicants and participants will provide information on whether they plan to implement recommended best practices from highly-regarded cybersecurity organizations (e.g., the Education Department, CISA, the National Institute of Standards and Technology (NIST), etc.) as part of the proposed Schools and Libraries Cybersecurity Pilot Program project.
35	Designated Cybersecurity Officer	Project Information	Applicants will provide information on their officer or other senior-level staff member that will be the designated cybersecurity officer and the tasks the officer will be responsible for.
36	Data and Metrics Collected by Applicant	Project Information	Applicants will provide a description of the data they will collect and the metrics they will use to assess the outcomes of the proposed Schools and Libraries Cybersecurity Pilot Program project, including, but not limited to, a description of how the project, will collect, track, and store such information.
37	Cost-Effectiveness Data and Metrics Collected by Service Provider	Project Information	Applicants will provide information on the data they will require their selected service providers to collect, track, and measure to determine the cost-effectiveness of Schools and Libraries Cybersecurity Pilot Program-funded cybersecurity equipment and services.
38	Awareness and Readiness Data and Metrics Collected by Service Provider	Project Information	Applicants will provide information on the data they will require their selected service providers to collect, track, and measure to determine the impact/effect on the applicants’ current cybersecurity awareness and readiness.
39	Non-monetary Challenges	Project Information	Participants will provide information on the non-monetary cybersecurity challenges they face and if/how the Pilot project will address them.
40	Current Cybersecurity Measures	Project Information	Participants will provide information on the current cybersecurity measures that they utilize.
41	Cybersecurity Training	Project Information	Participants will provide information about their cybersecurity training efforts, including, but not limited to, the number/percentage of students, school and library staff, and/or library patrons who receive cybersecurity training, and training participation rates.
42	Free and Low-Cost Cybersecurity Resources	Project Information	Applicants will provide information on whether they are utilizing or plan to utilize any of the free or low-cost cybersecurity resources identified/offered by the Education Department or CISA, and which resources they are utilizing/plan to utilize. Applicants who have not started to utilize the available free and low-cost cybersecurity resources should explain the impediments that are preventing them from doing so.
43	Impediments to Developing a More Robust Cybersecurity Posture	Project Information	If applicable, applicants will provide information on why they have not been able to take any preventative or mitigating actions to protect against cybersecurity threats and attacks and implement a more robust cybersecurity posture.
44	Ability of Proposed Pilot Project to be Self-Sustaining	Project Information	Applicants will provide information on whether/how they plan for the Schools and Libraries Cybersecurity Pilot Program project to be self-sustaining once established and after the Pilot Program ends.
45	Network Equipment, Hardware, and Software Services	Project Information	Applicants will provide information on any network equipment, and/or hardware or software services they plan to request as part of their Schools and Libraries Cybersecurity Pilot projects, including, but not limited to, any cloud services or third-party managed cybersecurity services.
46	Cybersecurity Protections for Broadband Networks and Data Outside of the Pilot Program	Project Information	Participants will provide information on whether they plan to obtain or upgrade any of their cybersecurity protections for their broadband networks and data outside of the Schools and Libraries Cybersecurity Pilot Program.
47	Implementation of Cybersecurity Recommendations or Framework Outside of Pilot Program	Project Information	Participants will provide information on whether they have resources to begin implementation of the Education Department’s and/or CISA’s cybersecurity recommendations and/or a cybersecurity program or framework.
48	Funding for Non-cybersecurity Equipment and Services That Support Cybersecurity Equipment and Services	Project Information	Applicants will provide information on whether their proposed Schools and Libraries Cybersecurity Pilot projects have funding for any non-cybersecurity equipment or services that they will use to support cybersecurity equipment or services and protect against cybersecurity threats and attacks.
49	Will Service Provider be Required to Include any No Cost Cybersecurity Equipment and/or Services	Project Information	Applicants will provide information on whether the applicant will require its selected service provider(s) to provide any cybersecurity equipment and/or services at no cost to the applicant, including a description of the applicable equipment and services.
50	Required Free and Low Cost Cybersecurity Resources	Project Information	Applicants and participants will provide information on any mandatory free and/or low-cost cybersecurity resources they expect their selected service providers to implement and utilize.
51	Estimated Costs of Pilot-Eligible Services and Equipment	Project Information	Applicants will provide estimated cost information for the services and equipment that they will seek funding for through the Schools and Libraries Cybersecurity Pilot Program.
52	Total Estimated Funding Request	Project Information	Applicants will provide the total estimated funding they anticipate requesting from the Schools and Libraries Cybersecurity Pilot Program for eligible cybersecurity equipment and services.
53	Estimated Applicant/Participant Share of Cost for Eligible Items	Project Information	Applicants and participants will provide their estimated share of the costs for eligible equipment and services for which they request funding under the Schools and Libraries Cybersecurity Pilot Program.
54	Estimated Applicant/Participant Cost for Ineligible Items	Project Information	Applicants and participants will provide the cost that they expect to pay for equipment and services that ineligible for funding under the Schools and Libraries Cybersecurity Pilot Program.
55	Total Estimated Pilot Project Cost	Project Information	Applicants and participants will provide the total cost that they estimate they will incur for participating in the Schools and Libraries Cybersecurity Pilot Program.
56	Sources of Support for Applicant’s/Participant’s Share of Cost for Eligible Items	Project Information	Applicants and participants will provide information on the sources of financial support they will use to pay their share of the cost for equipment and services that are eligible for funding under the Schools and Libraries Cybersecurity Pilot Program.
57	Plan to Cover Cost of Ineligible Items	Project Information	Applicants will provide information on the their plan to pay the cost of equipment and services that are ineligible for funding under the Schools and Libraries Cybersecurity Pilot Program.
58	Supporting Documentation	Project Information	Provides an option for the user to upload and submit documents to support their proposed Pilot Program project.
59	I am authorized to submit this application on behalf of the above-named applicant/participant and that based on information known to me or provided to me by employees responsible for the data being submitted, I hereby certify that the data set forth in this form has been examined and is true, accurate, and complete. I acknowledge that any false statement on this application or on any other documents submitted by this applicant can be punished by fine or forfeiture under the Communications Act (47 U.S.C. §§ 502, 503(b)), or fine or imprisonment under Title 18 of the United States Code (18 U.S.C. § 1001), or can lead to liability under the False Claims Act (31 U.S.C. §§ 3729-3733).	Certifications	The Authorized Person is required to make all required certifications and provide all required signatures.
60	In addition to the foregoing, this applicant/participant is in compliance with the rules and orders governing the Schools and Libraries Cybersecurity Pilot Program, and I acknowledge that failure to be in compliance and remain in compliance with those rules and orders may result in the denial of funding, cancellation of funding commitments, and/or recoupment of past disbursements. I acknowledge that failure to comply with the rules and orders governing the Schools and Libraries Cybersecurity Pilot Program could result in civil or criminal prosecution by law enforcement authorities.	Certifications	See Item No. 59 above.
61	By signing this application, I certify that the information contained in this form is true, complete, and accurate, and the projected expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise. (U.S. Code Title 18, §§ 1001, 286-287 and 1341, and Title 31, §§ 3729–3730 and 3801–3812).	Certifications	See Item No. 59 above.
62	The applicant/participant recognizes that it may be audited pursuant to its application, that it will retain for ten years any and all records related to its application, and that, if audited, it shall produce such records at the request of any representative (including any auditor) appointed by a state education department, the Administrator, the Commission and its Office of Inspector General, or any local, state, or federal agency with jurisdiction over the entity.	Certifications	See Item No. 59 above.
63	I certify and acknowledge, under penalty of perjury, that if selected, the schools, libraries, and consortia in the application will comply with all applicable Schools and Libraries Cybersecurity Pilot Program rules, requirements, and procedures, including the competitive bidding rules and the requirement to pay the required share of the costs for the supported items from eligible sources.	Certifications	See Item No. 59 above.
64	I certify under penalty of perjury, to the best of my knowledge, that the schools, libraries, and consortia listed in the application are not already receiving or expecting to receive other funding (from any source, federal, state, Tribal, local, private, or other) that will pay for the same equipment and/or services, or the same portion of the equipment and/or services, for which I am seeking funding under the Schools and Libraries Cybersecurity Pilot Program.	Certifications	See Item No. 59 above.
65	I certify under penalty of perjury, to the best of my knowledge, that all requested equipment and services funded by the Schools and Libraries Cybersecurity Pilot Program will be used for their intended purposes.	Certifications	See Item No. 59 above.
66	Name of Authorized Person	Signature	The Authorized Person is required to make all required certifications and provide all required signatures. This is the name of the Authorized Person certifying and submitting the form.
67	Title or Position of Authorized Person	Signature	This is the title or position of the Authorized Person certifying and submitting the form.
68	Date Submitted	Signature	Auto generated by system.
69	Date Signed	Signature	Auto generated by system.

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