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DRAFT

available only to one-in-core licensees and two low-VHF

collection and reduce the burden it causes you, please write the

licensees (i.e., those with two currently assigned channels

Federal

Communications

Commission,

AMD-PERM,

in 2 through 6).

Paperwork Reduction Project (3060-####), Washington, DC

20554. We will also accept your comments via the Internet if

you send them to Leslie.Smith@fcc.gov.

Please DO NOT

International Coordination.

SEND COMPLETED FORMS TO THIS ADDRESS.

Item 3:

International Coordination Pending Issue.

Remember - you are not required to respond to a collection of

information sponsored by the Federal government, and the

Licensee must answer whether it is electing a channel that

is subject to a pending international coordination issue.

government may not conduct or sponsor this collection, unless it

This is not a broad inquiry as to whether the channel is

displays a currently valid OMB control number or if we fail to

subject to coordination, but rather a narrow question to

provide you with this notice. This collection has been assigned

determine whether an international coordination issue is

an OMB control number of 3060-####.

preventing the licensee from obtaining its desired facilities.

If yes, licensee must attach as an Exhibit to this form an

THE FOREGOING NOTICE IS REQUIRED BY THE

explanation about its pending international coordination

PRIVACY ACT OF 1974, P.L. 93-579, DECEMBER 31,

issue.

1974, 5 U.S.C. 552a(e)(3), AND THE PAPERWORK

REDUCTION ACT OF 1995, P.L. 104-13, OCTOBER 1,

1995, 44 U.S.C. 3507.

FCC NOTICE TO INDIVIDUALS REQUIRED BY THE

PRIVACY ACT AND THE PAPERWORK REDUCTION

ACT

The FCC is authorized under the Communications Act of 1934,

as amended, to collect the personal information we request in

this form. We will use the information provided in the form to

determine the ultimate channel to be awarded for post-transition

DTV operation. If we believe there may be a violation or

potential violation of a FCC statute, regulation, rule or order,

your form may be referred to the Federal, state or local agency

responsible for investigating, prosecuting, enforcing or

implementing the statute, rule, regulation or order. In certain

cases, the information in your form may be disclosed to the

Department of Justice or a court or adjudicative body when (a)

the FCC; (b) any employee of the FCC; or (c) the United States

Government is a party to a proceeding before the body or has an

interest in the proceeding. In addition, all information provided

in this form will be available for public inspection.

If you owe a past due debt to the federal government, any

information you provide may also be disclosed to the

Department of Treasury Financial Management Service, other

federal agencies and/or your employer to offset your salary, IRS

tax refund or other payments to collect that debt. The FCC may

also provide this information to these agencies through the

matching of computer records when authorized.

If you file an incomplete form, the form may be returned

without action having been taken upon it. Your response is

required to participate in the digital channel election process.

We have estimated that each response to this collection of

information will take from __ minutes to __ hours.

Our

estimate includes the time to read the instructions, look through

existing records, gather and maintain the 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

Form Fcc 383 Draft - Digital Channel Election For Television Broadcast Station: First Round Conflict Decision Page 3

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