Fcc Form 327 Application For Cable Television Relay Service Station License (Page 2 of 12) in pdf

Minor changes do not require a fee (e.g., any name change not involving change in ownership or control of the license, or any change to

administrative information such as address, telephone number, or contact person, or any minor amendments or modifications such as lowering

power; removing one or more channels, deleting a path, etc.).

Refer to specific instructions for each schedule.

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 application to determine whether approving this application isin the public interest. If we believe there may be a violation or potential violation of a FCC

statute, regulation, rule 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 in 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 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 do not provide the information requested on this form, the application may be returned without action having been taken upon it or its processing may be delayed

while a request is made to provide the missing information. Your response is required to obtain the requested authorization.

We have estimated that each response to this collection of information will take 3 hours, on average. 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 collection and reduce the burden it causes you, please write the Federal Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-

0055), Washington, DC 20554. We will also accept your comments via the Internet if your send them to jboley@fcc.gov. Please DO NOT SEND COMPLETED

APPLICATIONS 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 of if we fail to provide you with this notice. This

collection has been assigned an OMB control number of 3060-0055.

THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, P.L. 93-579, DECEMBER 31, 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 327

Approved by OMB

3060-0055