Fcc Form 474 - Schools And Libraries Universal Service Service Provider Invoice (Page 4 of 4) in pdf

Fcc Form 474 - Schools And Libraries Universal Service Service Provider Invoice Page 4

Approved by OMB

OMB Control No. 3060-0856

Persons willfully making false statements on this form can be punished by fine or forfeiture, under the Communications Act,

47 U.S.C. Secs. 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. Sec. 1001.

FCC NOTICE FOR INDIVIDUALS REQUIRED BY THE PRIVACY ACT AND THE PAPERWORK REDUCTION ACT

Part 54 of the Commission’s Rules authorizes the FCC to collect the information on this form. Failure to provide all requested

information will delay the processing of the application or result in the application being returned without action. Information requested

by this form will be available for public inspection. Your response is required to obtain the requested authorization.

The public reporting for this collection of information is estimated to range from 1 to 2 hours per response, including the time for

reviewing instructions, searching existing data sources, gathering and maintaining the required data, and completing and reviewing the

collection of information. If you have any comments on this burden estimate, or how we can improve the collection and reduce the

burden it causes you, please write to the Federal Communications Commission, AMD-PERM, Paperwork Reduction Act Project (3060-

0856), Washington, DC 20554. We will also accept your comments regarding the Paperwork Reduction Act aspects of this collection

via the Internet if you send them to PRA@fcc.gov. PLEASE DO NOT SEND YOUR RESPONSE TO THIS FORM TO THIS ADDRESS.

Remember – 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 or if we fail to provide you with this

notice. This collection has been assigned an OMB control number of 3060-0856.

THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31, 1974, 5 U.S.C.

552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION

3507.

Do not staple the FCC Form 474.

Please submit this form to:

SLD SPI FCC Form 474

P. O. Box 7026

Lawrence, KS 66044-7026

For express delivery services or U.S. Postal Service, Return Receipt Requested, mail this form (pages 1-4) to:

SLD Forms

ATTN: SLD SPI FCC Form 474

3833 Greenway Drive

Lawrence, KS 66046

888-203-8100

Page 4 of 4

FCC Form 474

July 2013

Fcc Form 474 - Schools And Libraries Universal Service Service Provider Invoice Page 4