Application To Participate In An Fcc Auction Fcc 175 (Page 2 of 4) in pdf

Federal Communications Commission

Approved by OMB

Application to Participate in an FCC Auction

Washington, D. C. 20554

3060-0600

Schedule A (FCC Form 175)

(This schedule is to be used when applying to bid for wireless

licenses/markets.)

Applicant

Auction No.

FCC Account No.

Markets and Frequency Blocks/Channels for which you want to bid.

Market No.

Frequency Block/Channel No.

Enter Frequency Block/Channel Number(s) or Letter(s) or Check All

ALL

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(j)

(k)

(l)

(m)

(n)

The Communications Act of 1934, as amended, authorized the FCC to collect the personal information requested on this form. We will use the information provided

to determine whether approving this application is in the public interest. If we believe there may be a violation or potential violation of any statute, or FCC rule,

regulation or order, your application 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 on your application 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 the proceeding before the body or has an interest in the

proceeding. If you owe a delinquent debt to the federal government, the TIN and other information provided may also be disclosed to the Department of Treasury

Financial Management Services, 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. With the exception of the TIN, any information

provided on this form will be available for public inspection.

Public reporting burden for this information (including FCC Form 175 and this Schedule) is estimated to average 1.5 hours per response, including the time for

reviewing instructions, searching existing data needed, gathering and maintaining the data needed, and completing and reviewing the collection. You are not

required to respond to a collection of information sponsored by the Federal Government, unless it displays a currently valid OMB control number. The control

number for this collection is 3060-0600. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions

for reducing the burden, to the Federal Communications Commission, Paperwork Reduction Project (3060-0600), Performance Evaluation and Records

Management, Washington, D. C. 20554. DO NOT SEND COMPLETED APPLICATION FORMS TO THIS ADDRESS.

THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, P.L. 93-579, DECEMBER 31, 1975, 5 U.S.C. SECTION 552a(e)(3)

AND THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, 44 U.S.C. SECTION 3507.

FCC 175 (Schedule A)

October 2000