Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund.

Forms and Documents

Document Name	Status
Form FCC Form 1876 Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund Form	Unchanged
3060-1223_OMD (072017).docx Supporting Statement A	2017-07-14

IC Document Collections

IC ID	Document Title	Status
224901	Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund	Unchanged
224900	Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund Form	Unchanged

ICR Details

OMB Control No: 3060-1223	ICR Reference No: 201706-3060-021
Status: Historical Active	Previous ICR Reference No: 201702-3060-016
Agency/Subagency: FCC	Agency Tracking No: OMD/Financial Operations
Title: Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund.
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/27/2017
	Date Received in OIRA: 07/25/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved	09/30/2017
Responses	2,000	0	2,000
Time Burden (Hours)	6,000	0	6,000
Cost Burden (Dollars)	0	0	0

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Abstract: FCC is conducting a reverse auction to determine the amount of compensation that each broadcast television licensee would accept in return for voluntarily relinquishing some or all of its broadcast television spectrum usage rights in order to make spectrum available for assignment through a system of competitive bidding. This information collection is a standardized form for successful bidders in the reverse auction to submit additional information to facilitate incentive payments.

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Authorizing Statute(s): PL: Pub.L. 112 - 96 6403(b)(4)(A) Name of Law: Middle Class Act Tax Relief and Job Creation Act of 2012 (Spectrum Act)
  

Citations for New Statutory Requirements: PL: Pub.L. 112 - 96 6403(b)(4)(A) Name of Law: Middle Class Act Tax Relief and Job Creation Act of 2012 (Spectrum Act)

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 22542	05/16/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 34520	07/25/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund	FCC Form 1876, FCC Form 1876	Relocation Reimbursement Form ,   Relocation Reimbursement Form
Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,000	2,000	0	0	0	0
Annual Time Burden (Hours)	6,000	6,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $66,920

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/25/2017

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