Form 161 - Cores Update And Change Form (Page 4 of 4) in pdf

Form 161 - Cores Update And Change Form Page 4

If you owe a past due debt to the Federal Government, the Taxpayer Identification Number (such as your

Social Security Number) and other information you provide may also be disclosed to the Department of the

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.

We have estimated that each response to this collection of information will take, on average, 15 minutes.

Our estimate includes the time to read the instructions, look through existing records, gather and maintain

required data, and actually review and complete the form. If you have any comments on this estimate, or on

how we can improve the collection of this data to reduce the burden it causes you, please write the Federal

Communications Commission, AMD-PERM, Washington, DC 20554, Paperwork Reduction Project (3060-

0918). We will also accept your comments via the Internet if you send them to Judith-B.Herman@fcc.gov.

Please DO NOT SEND COMPLETED APPLICATION FORMS 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 3060-0918.

This notice is required by the Privacy Act of 1974, Public Law 93-579, December 31, 1974, 5 U.S.C. Section

552a(e) (3) and the Paperwork Reduction Act of 1995, Public Law 104-13, October 1, 1995, 44 U.S.C. 3507.

Form 161 - Cores Update And Change Form Page 4