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pdfGPO PKI Registration Form
SECTION 1 (This section to he completed by applicant prior to in-person Registration)
USER INFORMATION (Please print)
First Name
Email Address
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User's Agency ~ a m d ( ~ r i n t ) :
MiddleName
Last Name
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Telephone#
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U. S. Dewr+rned o f
User's Address:
(202) 482-3 781
Commerce
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Wash,
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ID#
Fed. Gov't-issued Picture ID
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Fed. Gov't-issued Picture ID
Non-Fed. Gov't-issued Picture ID
ID#
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ErnDhveebsID hdqc.
Type
136q789
Type
I declare under penalty of perjury that the foregoing is
I declare under penalty of perjury that the foregoing is t
Executed on:
-
/0-// 62007
SECTION 2.
(date) Signature:
(This section to be completed by Registration Authority and User a t time of Registration)
RA INFORMATION (Please print)
RA First Name
RA Last Name
RA Telephone #
Date of Registration Request
RA Email Address
Date:
Fed. Gov't-issued Picture ID verified
Yes
No
N/A
Non-Fed. Gov't-issued Picture ID verified
Yes
No
NIA
Non-Fed. Gov't-issued ID verified
Yes
No
[7 NIA
PKI Credential Type (software or smartcard)
Software (.epf file)
Smartcard Serial Number:
(if smartcard credential)
Smartcard Type (if smartcard credential):
(vendor and model number)
PKI Credential Issuance Completed
User Name (CN)
Yes
No
Date and Time:
Cn=
User's Agency Name (print):
User Name (print)
User Signature
I declare under penalty of perjury that the foregoing is true and correct.
Executed on:
(date) Signature:
RA Signature
I declare under penalty of perjury that the foregoing is true and correct.
Executed on:
(date) Signature:
Smartcard
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,
UNITED STATES DEPARTMENT OF COMMERCE
Chief Information Officer
Wash~ngton,D.C. 20230
Ms. Susan E. Dudley
Administrator
Office of Information and Regulatory Affairs
Office of Management and Budget
Washington, DC 20503
Dear Ms. Dudley:
The Department of Commerce's National Telecommunication and Information Administration
(NTIA) requests expedited review of an information collection request, "NTIA Message Testing
Focus Groups for the Digital-to-Analog Converter Box." We request that the Office of
Management and Budget conclude its review by October 17,2007.
Congress directed the National Telecommunications and Information Administration (NTIA) to
create and implement a program to provide coupons for consumers to purchase digital-to-analog
converter boxes (See Title I11 of the Deficit Reduction Act of 2005, Pub. L. No. 109-171,
120 Stat. 4,21 (Feb. 8,2006)). These converter boxes are necessary for consumers who wish to
continue receiving broadcast programming over the air using analog-only television sets after
February 18,2009 - - the date that television stations are required by law to cease analog
broadcasting. On March 15,2007, NTIA published a Final Rule establishing the parameters of
the Coupon Program and describing the rights and responsibilities of interested parties.
In accordance with the Act, and its own regulations, NTIA must accept applications from
consumers for these coupons beginning January 1,2008.
In an effort to ensure materials and messages developed for the campaign resonate with all
targeted audiences, these items must be tested with representatives of these segments.
The targeted audiences, identified as the more reliant on over-the-air television, include the
following: (1) economically disadvantaged households; (2) rural residents; (3) minorities;
(4) people with disabilities; and (5) seniors. NTIA, through its contractor, will conduct focus
groups to develop an application that ensures consistent messaging and avoid confusion to
consumers. Once the information is developed from these focus groups, NTIA will submit the
application to OMB for approval.
This expedited review is necessary to conduct the focus groups sessions. These steps will enable
consumers to apply for converter box coupons by the statutory mandated date of January 1,
2008. If focus groups are not used to collect this information, the consumer education campaign
as well as the application process may be confusing to consumers. As a result, households that
rely solely on over-the-air broadcasts may not apply for coupons, and thereby lose access to
television after February 17,2009.
We appreciate your assistance in this matter.
Sincerely,
Barry C. West
"
F
File Type | application/pdf |
File Modified | 2007-10-17 |
File Created | 2007-10-17 |