FCC Form 2100 Schedule 399 Instructions (clean 2019)(final)

Approved by OMB

3060-1178

INSTRUCTIONS FOR TV BROADCASTER RELOCATION FUND REIMBURSEMENT FORM (FCC Form 2100, Schedule 399)

NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995

We have estimated that each response to this collection of information will take on average of 1 - 4 hours, depending upon the submission type. Our estimate includes the time to read the instructions, look through existing records, gather and maintain 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, Washington, DC 20554, Paperwork Reduction Project (3060-1178). We will also accept your comments via the Internet if you send them to PRA@fcc.gov. Please do not send completed application forms to this address.

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 with this notice. This collection has been assigned OMB control number 3060-1178.

GENERAL INSTRUCTIONS

Introduction

The TV Broadcaster Relocation Fund Reimbursement Form, FCC Form 2100, Schedule 399 (Reimbursement Form), is to be used to request reimbursement of certain costs incurred as a result of the post-incentive auction broadcast transition. See Middle Class Tax Relief and Job Creation Act of 2012, Pub. L. No. 112-96, §§ 6402, 6403, 125 Stat. 156 (2012) (Spectrum Act); see also Expanding the Economic and Innovation Opportunities of Spectrum Through Incentive Auctions, GN Docket 12-268, Report and Order, FCC 14-50, 29 FCC Rcd 6567 (2014) (“Incentive Auction Order”); Consolidated Appropriations Act 2018, Pub. L. No. 115-141, at Division E, Title V, § 511, 132 Stat. 348 (2018) (codified at 47 U.S.C. § 1452(j)-(n)) (Reimbursement Expansion Act or REA); LPTV, TV Translator, and FM Broadcast Station Reimbursement; Expanding the Economic and Innovation Opportunities of Spectrum Through Incentive Auctions, Report and Order, FCC 19-21, (2019) (REA Report & Order). This form will be used by television and radio stations and MVPDs claiming reimbursement to submit: (1) an estimate of relocation costs in advance of transition construction (estimated cost form); (2) invoices, receipts, and other documentation of costs in connection with requests for payment from the TV Broadcaster Relocation Fund (Fund) (actual cost form); (3) final accounting for the total expenses incurred, and (4) certification of eligibility for low power TV (LPTV) and TV Translator stations (LPTV/translators) and FM Stations. Please note that not all sections must be completed at each phase. In addition, full power and Class A stations will submit progress reports during the reimbursement period, as directed by the Media Bureau.

Edition Date: July 2019

Applicable Rules and Regulations

Before preparing this form, please review the relevant portions of Section 73.3700, particularly 73.3700(e) (Reimbursement Rules), in Title 47 of the Code of Federal Regulations (CFR). A copy of Title 47 may be found online at www.ecfr.gov. Applicants should also review the Incentive Auction Order, and other FCC directives relevant to reimbursement of relocation costs in GN Docket No. 12-268 (Expanding the Economic and Innovation Opportunities of Spectrum Through Incentive Auctions) and MB Docket No. 16-306 (Post-Incentive Auction Transition) and MB Docket No. 18-214 (LPTV, TV Translator, and FM Broadcast Station Reimbursement). A copy of the Incentive Auction Order and other relevant information about this proceeding can be found on the FCC’s website at www.fcc.gov. Applicants must file complete and accurate forms in compliance with the rules. The applicant’s responses to questions on this form and statements constitute representations on which the FCC will rely in considering payments to the applicant from the Fund.

Background

The Spectrum Act provides for the reorganization of the broadcast television spectrum in conjunction with an incentive auction in which television licensees voluntarily relinquish spectrum usage rights (reverse auction) in exchange for a share of the proceeds from the sale of repurposed spectrum to wireless providers (forward auction). During this process, television channels were reassigned or repacked and some television broadcasters who remain on the air after the auction are required to move to a new channel. Full power and Class A television licensees are eligible for reimbursement of costs “reasonably incurred” in relocating to new channels assigned in the repacking process and MVPDs for costs reasonably incurred in order to continue to carry the signals of stations relocating to a new channel as a result of the repacking process or a winning reverse auction bid. The REA authorizes the Commission to reimburse costs reasonably incurred by certain LPTV/translator stations to relocate their television service from one channel to another channel or otherwise modify their facilities as a result of the reorganization of broadcast television spectrum. The REA also allocated funds for the purpose of reimbursing costs reasonably incurred by an FM broadcast station for facilities necessary for such station to reasonably minimize disruption of service as a result of the reorganization of broadcast television spectrum. The Spectrum Act provides that reimbursements be made from the TV Broadcaster Relocation Fund and that the amount available for reimbursement of relocation costs is $1.75 billion. The REA appropriated a total of $1 billion in additional funds, increasing the total to $2.75 billion. In implementing the REA, the Commission determined that beyond the REA’s direction that not more than $150 million be used to reimburse LPTV/translator stations and not more than $50 million be used to reimburse FM stations, reimbursement of full power and Class A stations and MVPD would be prioritized over payment of LPTV/translator and FM stations. The REA directed that the funds are available until not later than July 3, 2023 (Reimbursement Period). The Reimbursement Period began when the Commission issued a Public Notice announcing the new channel assignments for television stations being repacked (Channel Reassignment PN) on April 13, 2017.

Broadcasters and MVPDs Eligible for Reimbursement

Full Power and Class A Television broadcasters: Only full power and Class A television licensees that are involuntarily reassigned to new channels in the repacking process pursuant to Section 6403(b)(1)(B)(i) of the Spectrum Act are eligible for reimbursement of relocation costs.

Channel sharing stations: Only “Sharer” television stations that serve as the host station in a channel sharing arrangement are eligible for reimbursement and only in the event that the shared facility receives a new channel assignment in the repacking process. A “sharer” is a station that does not relinquish its spectrum, but shares its frequency with one or more “sharee(s)” – a station that relinquishes its frequency in order to move to the sharer’s frequency.

MVPDs: MVPDs are eligible for reimbursement of costs reasonably incurred by in order to continue to carry the signal of: (1) a full power or class A television station that is involuntarily reassigned in the repacking process; (2) channel sharer stations that are involuntarily reassigned in the repacking process; (3) a broadcast television licensee that voluntarily relinquishes spectrum usage rights with respect to a UHF channel in return for receiving spectrum usage rights with respect to a VHF channel; (4) a broadcast television licensee that voluntarily relinquishes spectrum usage rights with respect to a high VHF channel in return for receiving spectrum usage rights with respect to a low VHF channel; and (5) a broadcast television licensee that voluntarily relinquishes spectrum usage rights to share a television channel with another licensee.

LPTV/Translator Stations: A low power television or TV translator station, as defined by 47 CFR § 74.701, that was an LPTV/translator station licensed and transmitting for at least 9 of the 12 months prior to April 13, 2017, and that filed for, and was granted, a construction permit application in the post-incentive auction Special Displacement Window.

FM Stations: Full-service, translator, and low-power FM stations, as defined by 47 CFR §§ 73.310 and 74.1201, that were licensed and transmitting prior to April 13, 2017, at a facility impacted by a full power or Class A station that was reassigned as a result of the incentive auction and that incurred costs to reasonably minimize disruption of service as a result of the reorganization of broadcast television spectrum because the station was forced to: (1) relocate permanently, (2) temporarily dismantle equipment or make other changes not requiring commission approval stations forced to (3) temporarily reduce power or cease transmission on their primary facility to accommodate antenna or tower modifications.

Definitions

Estimated Cost Form: Broadcasters and MVPDs seeking reimbursement from the Fund will use this form to provide an estimate of relocation costs in advance of transition construction (see 47 CFR § 73.3700(e)(2)).

Initial Allocation: Broadcasters and MVPDs that submit estimated cost forms will receive an initial allocation of funding of up to 80 percent of their estimated costs. Broadcasters and MVPDs will then be able to draw down against this amount as they incur expenses related to the channel transition.

Actual Cost Form: Broadcasters and MVPDs that received an initial allocation will use this form to submit invoices, receipts, and other documentation of costs in connection with requests for payment from the TV Broadcaster Relocation Fund.

Catalog of Potential Expenses and Estimated Costs (cost catalog): The cost catalog is a list, embedded in the Form, that contains some of the expenses broadcasters and MVPDs will incur during the repacking process that may be eligible for reimbursement and the estimated cost of each service and piece of equipment.

Predetermined Cost Estimate: The estimated cost of an eligible expense as generally determined by the Media Bureau in the cost catalog (see 47 CFR § 73.3700(a)(10)).

Individualized Cost Estimate: Cost estimate provided by the entity seeking an initial allocation that differs from the cost catalog, either because the entity believes the catalog cost is too low or because the item or service is not included in the cost catalog. In either situation, entities submitting individualized cost estimates must submit supporting evidence and certify that the estimate is made in good faith.

Reimbursement Period: The period beginning on April 13, 2017 and ending not later than July 3, 2023.

Final Allocation Deadline: Upon completing construction or other reimbursable changes, or by a specific deadline prior to the end of the Reimbursement Period to be established by the Media Bureau, whichever is earlier, all broadcast stations and MVPDs that received an allocation from the TV Broadcaster Relocation Fund must provide the Commission with information and documentation, including invoices and receipts, regarding their actual expenses incurred as of a date to be determined by the Media Bureau. If a broadcast station or MVPD has not yet completed construction or other reimbursable changes by the Final Allocation Deadline, it must provide the Commission with information and documentation regarding any remaining eligible expenses that it expects to reasonably incur (see 47 CFR § 73.3700(e)(3)(i)).

Final Accounting: After completing all construction or reimbursable changes, broadcast stations and MVPDs that have received money from the TV Broadcaster Relocation Fund will be required to submit final expense documentation containing a list of estimated expenses and actual expenses as of a date to be determined by the Media Bureau.

Reimbursement Process

The Commission will reimburse eligible entities by calculating an initial allocation of funds to each broadcaster and MVPD based on its estimated costs. As discussed below, all entities claiming reimbursement from the Fund must file an estimated cost form. Broadcasters and MVPDs will draw down against their allocation amount as they incur expenses and submit evidence thereof.

Broadcasters and MVPDs may use the predetermined cost estimates in the cost catalog to complete their estimated cost form, or may provide their own cost estimates for the equipment and services they expect to purchase. Broadcasters and MVPDs must provide a written justification explaining any estimate that exceeds the amount published in the catalog and any estimate for a service or piece of equipment for which there is no cost estimate in the catalog. Although the Media Bureau will base each entity’s initial allocation on its estimated costs, eligible entities will only be reimbursed for their actual costs reasonably incurred for eligible repacking expenses. The cost catalog is embedded within the Reimbursement Form. Prior to the end of the three-year Reimbursement Period, entities will provide information regarding their actual costs and any remaining estimated costs to complete construction. If necessary to cover remaining costs, broadcasters and MVPDs may request an additional allocation of funds prior to the end of the Reimbursement Period.

Banking Information for Payment

The Commission will use its in-house vendor payment system, Genesis, to disburse reimbursement payments to broadcasters and MVPDs. As an initial step in filing the Reimbursement Form, an entity must identify which address from among those listed for the entity in the Commission Registration System (CORES) it wishes to use to receive reimbursement payments (all the entity’s CORES addresses with valid banking information will appear).

Any entity doing business with the Commission must register using the CORES to receive a unique 10-digit FCC Registration Number (FRN). If a broadcaster or MVPD wants its reimbursement payments to go to a bank account not listed in CORES, it must update its information in CORES. CORES can be accessed at https://apps.fcc.gov/coresWeb/publicHome.do.

Filing FCC Form 2100, Schedule 399 in the Media Bureau’s Licensing and Management System (LMS)

Entities will file FCC Form 2100, Schedule 399 electronically by accessing LMS. Only electronic submissions filed via LMS will be accepted. Supporting cost documentation, such as invoices, and progress reports (as required) will be uploaded to LMS along with the form. To access LMS, or find more information about this system, go to https://enterpriseefiling.fcc.gov/dataentry/login.html.

Estimated Costs

All entities seeking reimbursement from the Fund must file their estimated costs on FCC Form 2100, Schedule 399. A separate form must be filed for each television broadcast station. Cable operators and DBS providers may file a single form for multiple physical system identification numbers (PSIDs) or receive sites. Full power and Class A television stations were required to file their form no by July 13, 2017, three months following release of the Channel Reassignment PN. LPTV/translator and FM stations will file their forms by a date announced by the Media Bureau.

The Media Bureau will consider any late-filed forms on a case-by-case basis.

Full power and Class A stations will provide an estimate of the costs they expect to reasonably incur to change channels; MVPDs will provide an estimate the costs they expect to reasonably incur to accommodate new channel assignments; LPTV/translator stations will provide an estimate of the costs they expect to reasonably incur to construct or modify facilities as authorized in their Special Displacement Window construction permit; FM stations will provide an estimate of reasonable costs to reasonably minimize disruption of services. Entities must submit a revised form if circumstances change substantially. For example, a revised form is required if a broadcaster or MVPD becomes aware of a substantial expense that was not identified on the initial form or if the entity changes its construction plan that requires a claim from the Fund for equipment or services that are different from those listed on the initial estimated cost form.

Broadcasters and MVPDs must also provide a description of the existing equipment for which they are seeking reimbursement to modify or replace. This will help establish a baseline against which to assess whether the reimbursement requested for new or modified equipment is reasonable.

LPTV/translator and FM stations must also file an Eligibility Certification and supporting documentation.

A catalog of costs is embedded within FCC Form 2100, Schedule 399. The catalog consists of a list of many, but not necessarily all, of the equipment and services a television station may have to purchase in order to change its channel. The catalog also includes a predetermined estimate of the cost, or range of costs, for equipment and other expenses associated with most of those modifications. Similarly, for MVPDs, the catalog contains a list of many, but not necessarily all, of the cable or satellite system changes an MVPD may be required to make to accommodate new station channel assignments, as well as predetermined estimates of the costs or cost ranges for most of those changes.

When submitting their estimated costs, if there is a predetermined cost estimate for a particular service or type of equipment, stations and MVPDs may select either the predetermined cost estimate or provide their own estimate if they believe the predetermined estimate does not fully account for their specific circumstances. Entities that reject the predetermined estimate as too low must type an explanation to justify the higher cost in the text box within the on-line version of the form. For any expenses for which there is no predetermined cost estimate, the station or MVPD must provide an individualized cost estimate, submit supporting evidence, and certify that the estimate is made in good faith. Expenses entered in each section of the form will be automatically totaled. In addition, the overall total for all estimated expenses will be calculated automatically and shown on the form.

Actual Costs

All entities seeking reimbursement from the Fund must use this form to provide documentation to substantiate their expenses. Entities will be able to draw down against the amount allocated for their transition as they incur expenses during the construction period. When submitting cost documentation, an entity must upload substantiating cost documentation (a receipt or invoice) and enter the amount claimed for each item or service on the form. Upon logging in to LMS and accessing its form to claim actual costs, an entity will see the cost estimates it submitted previously, as well as any previously submitted actual expenses. It is anticipated that entities will submit actual expenses multiple times throughout the reimbursement period, as they incur expense. The electronic version of the form will keep a running total of submitted expenses, which will be visible each time the entity logs in to the form.

An expense may have more than one cost document associated with it (for example, if an expense is paid in multiple installments, there may be more than one invoice charging for each installment). Conversely, a single invoice may relate to more than one reimbursable item (for example, an invoice that includes costs for tower mapping as well as tower rigging). In that case, an entity may utilize the document more than once so that it is associated with each appropriate expense category.

An entity may continue to submit documentation substantiating incurred expenses even if it has drawn down the entire amount of its initial allocation(s). All cost documentation submitted will be captured on this form and will be considered at the final allocation stage.

Final Allocation and Accounting

All entities that received an initial allocation(s) from the Fund must use this form to submit final documentation regarding their actual expenses incurred (if construction is complete) or paid to date, plus any remaining estimated expenses (if construction is not complete). Each entity’s final form must be submitted either upon completion of construction, or by a deadline prior to the end of the Reimbursement Period to be announced by the Media Bureau, whichever is earlier. That is, an entity must meet the filing deadline even when the broadcaster or MVPD has not yet completed its transition.

Entities must certify that the amount reflected on the actual cost form represents the amount actually paid to vendors for expenses eligible for reimbursement from the Fund, including any discounts, credits, refunds, or rebates. Broadcasters and MVPDs may request an additional allocation at this phase, if needed to cover additional reimbursable costs.

It is possible that some broadcasters and MVPDs will not complete their transition before the filing deadline. By the deadline, these entities must submit documentation for costs incurred to date plus additional documentation such as written estimates or purchase orders related to anticipated, but not yet incurred, expenses. Once these stations and MVPDs complete construction or incur other reimbursable changes, even if this occurs after the end of the Reimbursement period, they must file a final accounting with cost documentation of incurred expenses.

Filing Fees

There is no fee for filing this form.

Assistance with Reimbursement Form

For assistance with this Form, contact the Media Bureau’s Relocation Fund Reimbursement hotline at 202-418-2009 or by e-mail at reimburse@fcc.gov.

FORM INSTRUCTIONS

SECTION I – APPLICATION TYPE

Question 1: The system will pre-populate, based on login information, whether the applicant is an MVPD or broadcaster, the FCC-assigned facility identification number for broadcasters (Facility ID), and the MVPDs type (cable operator, or DBS/other). MVPDs must provide their FCC-assigned physical system identification numbers (PSIDs) or equivalent special-purpose identifiers (for non-cable operators). The form will pre-fill the legal name of the entity, any d/b/a associated with the entity, and the address and phone number as currently recorded in the Commission’s LMS (for broadcasters) or COALS (for MVPDs).

Question 2: The system will determine whether this form is being used to submit estimated costs, actual cost documentation, or to provide final allocation or accounting information.

SECTION II – CONTACT INFORMATION

Question 1: The form will pre-fill with information currently in the FCC’s database regarding the contact information for the applicant. Indicate whether this prefilled information is correct. If not, applicant must correct the information in the appropriate FCC database (LMS or COALS) prior to submitting this form.

Question 2: The entity’s FRN, used to log in to the on-line form, will pre-populate this line. Every CORES address linked to the entity’s FRN for which there is valid bank account information in the Commission’s CORES system will appear. Choose the CORES address associated with the bank account the applicant elects to receive its reimbursement payments. If in no address appears, the applicant must log in to CORES to set up an account or append banking information to one or more existing CORES addresses.

Question 3: Provide the name, title, street address, telephone number, and email address of the individual who should be contacted by the FCC in the event any questions arise with respect to the information on this reimbursement form. If this individual is the same as the same as the contact listed for the CORES account selected, choose “same as CORES address.”

Question 4: The entity’s FRN, used to log in to LMS, will be pre-populated here.

Question 5: Provide the following information about the individual primarily responsible for preparing this form: name, title, company, street address, telephone number and email address. If this individual is the same as the same as the contact listed for the CORES account selected, choose “same as CORES address.” If this individual is the same as Question 3, choose “Same as Reimbursement Contact.”

SECTION III – CERTIFICATION OF ELIGIBILITY FOR LPTV/TV TRANSLATOR AND FM STATIONS

1. LPTV/TV Translator Eligibility:

   1. In the indicated field, provide the LMS File Number of the Granted Displacement Construction Permit.

      1. If the station cannot provide an LMS File Number, state whether it completed its Construction Permit and filed the License to Cover.

   2. If, as of April 13, 2017, the station was licensed or had an application for license (FCC Form 2100 Schedule D) pending, check the “Yes” box.

   3. If the station was licensed and transmitting for at least 2 hours in each day of the week, and at least a total of 28 hours per calendar week for 9 of the 12 months prior to April 13, 2017, then:

1. check the “Yes” box; and

2. attach true copies of documents or other evidence that demonstrate the station’s operation as described in Section 1.c., above.

4. Licensee is not requesting reimbursement from the Fund for payments previously received, or expected to be received, from the Fund; or for reimbursement of expenses paid by, or expected to be paid by, any other source. Check “Yes” to certify. This certification means that no other party, including the TV Broadcaster Relocation Fund, has reimbursed the licensee for any expenses associated with television repacking work, or is expected to make any payments to the licensee to reimburse it for expenses claimed on this form.

1. FM Eligibility:

   1. Provide in the indicated fields the Facility ID number(s) of the repacked full power or Class A television station(s) causing the FM licensee to incur costs as a result of the broadcast spectrum repacking. This will be a full power television or Class A television station whose antenna is located on the same tower as the FM licensee, or is located on another tower near to the FM licensee’s antenna, causing the FM licensee to have to reduce power, cease transmitting, dismantle its antenna, or move its antenna to a new site.

   2. Licensee certifications: The FM licensee must certify, by checking the boxes provided, each of the following:

      1. That it was transmitting on April 13, 2017

      2. That as a result of repacking of the full power or Class A television station(s) whose Facility ID numbers were listed in response to question 2(a), above, the FM licensee’s station is required to do at least one of the following. Licensee should check all that apply, but at least one of the following boxes:

         1. Permanently relocate its main transmission site. Check if the licensee must move its station’s main transmission antenna to a different site to accommodate television channel repacking.

         2. Temporarily dismantle all or some of the facilities at its main transmission site. Check if television channel repacking work at the licensee station’s main transmission site requires that the antenna or other equipment (e.g., transmitter, coaxial cable or wave guides) be temporarily dismantled to accommodate repacking work. For example, if the FM station’s antenna must be dismantled to enable the placement of a new television antenna above the FM station antenna on the same tower, but the FM antenna will be replaced once the new television antenna is mounted, the FM licensee would check this box.

         3. Construct or modify interim auxiliary facilities to avoid unreasonable disruption of broadcast service. The FM licensee should check this box if it is necessary to construct a new auxiliary facility to avoid disruption of service, or to upgrade an existing auxiliary facility to avoid service disruption. In order to qualify for reimbursement for construction or modification of interim auxiliary facilities, the following must apply:

            1. The FM licensee’s station’s primary or existing auxiliary facilities would lose coverage to more than 20 percent of the station’s normal covered population OR would lose coverage to more than 20 percent of the station’s normal coverage area, and

            2. Service described above would be lost for more than 24 hours, and the service loss will not be limited to the hours of 12:00 midnight to 5:00 a.m. local time. Thus, if service disruption lasts for less than 24 hours, or if all service disruption occurs between midnight and 5 a.m. local time, the FM licensee may not claim reimbursement for constructing or modifying auxiliary facilities. If the FM licensee meets both the loss of coverage criterion and the time of service loss criterion, it should check “Yes” to this question and proceed to the attachments immediately below.

            3. If the FM licensee checked “Yes” to Section III.2.b.iii.3 above (the question indicating that the licensee qualifies for reimbursement to construct or modify auxiliary facilities), the FM licensee must provide the following information and attachments:

               1. Contour maps showing the 60 and 70 dBu contours from the station’s main transmission site, for both normal full-power transmission and reduced-power transmission, due to television repacking work. These should include the total area covered by all contours, and the total population covered for all contours, based on Census Bureau population centroids. Check “Yes” to indicate this attachment is being provided, and click the “File Attachment” link to upload the attachment.

               2. Contour maps showing the 60 and 70 dBu contours from the station’s interim auxiliary transmission site, for both normal full-power transmission and reduced-power transmission, due to television repacking work. These should include the total area covered by all contours, and the total population covered for all contours, based on Census Bureau population centroids. Check “Yes” to indicate this attachment is being provided, and click the “File Attachment” link to upload the attachment.

               3. Provide all date(s) and time(s) that broadcast transmissions at the main transmission site are or were required to cease or operate at reduced power as a result of television repacking work at the station’s primary facility. Note that the dates and times may not be continuous; if the station, for example, is required to reduce power for one week, resumes operation for one week, and must reduce power again for one week, list only the dates and times when reduced power was required.

               4. Provide all date(s) and time(s) that broadcast transmissions are or will be made from the interim auxiliary facilities constructed or to be constructed using funds from the TV Broadcaster Relocation Fund. Note that, if repacking work is interrupted or intermittent, these dates and times also may not be continuous.

      3. Licensee is not requesting reimbursement from the Fund for payments previously received, or expected to be received, from the Fund; or for reimbursement of expenses paid by, or expected to be paid by, any other source. Check “Yes” to certify. This certification means that no other party, including the TV Broadcaster Relocation Fund, has reimbursed the licensee for any expenses associated with television repacking work, or is expected to make any payments to the FM licensee to reimburse it for expenses claimed on this form.

SECTION IV– BROADCASTER INFORMATION AND TRANSITION PLAN

A – Station Information

The form will prefill information for the station currently in the FCC’s LMS and Kidvid databases. If this information is incorrect, the applicant must correct the information in the appropriate FCC database prior to submitting this form.

Question 1: Indicate whether the station is participating in a channel sharing arrangement and, if so, provide the facility identification number of the sharee station. [Note: A channel “sharee” is a station participating in a channel sharing arrangement that relinquishes its frequencies in order to move to the sharer’s frequencies.] The form will prefill information currently in the FCC’s database regarding the sharee station. If the pre-populated information for the sharee station is incorrect, the applicant must direct the sharee station to correct the information in the appropriate FCC database, as indicated on the form, prior to submitting the form.

Question 2: In this text box, provide a brief description of the steps the station must take to complete its transition, including its plan for interim operations. Identify the specific equipment currently used by the station that will be used for interim operations and for post-transition operation and the new equipment that will be purchased, including the transmitter(s), antenna(s), transmission line(s), and tower(s). If appropriate, indicate the channel the station expects to use for interim operations and the length of time the station expects to operate with interim facilities while construction of the main facility is underway.

For example:

“Install existing auxiliary/backup antenna on the tower used for the station’s auxiliary facility, use existing auxiliary/backup antenna for interim operations on existing channel , remove existing primary antenna from the tower used for the station’s primary facility, reinforce existing tower used for primary facility, install new primary antenna. We plan to use our existing channel for interim operations. Work on the primary tower and facility will be done during early morning hours over a period of approximately two weeks.”

B – Broadcaster Estimated or Actual Transition Expenses

1. Transmitters

Question 1: This question contains a list of possible changes the station might have to make to its transmitter(s) in order to transition to its new channel. Check all that apply.

In answering this question, the applicant should consider the following. In addition to the station’s existing primary transmitter, the station may currently have one or more auxiliary transmitter(s). One or more of these transmitters may be able to be retuned to operate on the new channel, or may have to be replaced. During its transition to the new channel, the station may also need to use a transmitter for interim operations while work is being performed on the primary transmitter (i.e., retuning or replacement). The station may have an existing auxiliary transmitter that can be used for interim operations or may have to purchase or lease another transmitter for that purpose.

The applicant should answer Question 1 only for transmitters currently used by the station that are operational and necessary for that station’s operations. Reimbursement is not available for equipment that is not in working order.

Question 2: For each transmitter the station currently uses to serve its licensed facility, describe the purpose for which the transmitter is used (e.g., primary or auxiliary) and indicate if the transmitter is owned by the station or a company affiliated with the station (e.g., a group station owner) or if the transmitter is rented or leased. If the transmitter is leased, provide the name and contact information for the owner. In addition, for each transmitter indicate whether the transmitter is shared with another station and, if so, provide the facility ID number of the station(s) with which the transmitter is shared. Also, for each transmitter indicate the manufacturer, model, year manufactured, and the transmitter type and power capacity.

DTS stations. Stations that indicate they operate with a distributed transmission system (DTS) will find each DTS site prefilled in the system. These stations will then be prompted to provide answers to Question 2, 3, and 4 in this subsection (Transmitters and In-Building Expenses) for each site in the system.

Question 3:

1. Retuning costs. For each transmitter the station indicated would be retuned (see Question 1, above), indicate the type of banding issue (major or minor) posed by retuning. A description and definition of major and minor banding issues is included in the catalog of costs. Also indicate the type of new mask filter required and whether a new exciter is required and, if so, the type.

2. New transmitter costs. For each new transmitter the station indicated it would purchase (see Question 1, above) indicate the type and power capacity of transmitter the station intends to purchase. In addition, provide a justification as to why the station thinks it is reasonable under the circumstances to purchase a new transmitter rather than modify its current transmitter.

3. Other transmitter costs. Indicate whether the station will incur the following kinds of other transmitter-related costs: 1) electrical service, 2) HVAC service, 3) a transmitter building addition or modification, 4) costs associated with a move to Channel 14, or 5) an interior RF system. Stations estimating or claiming transmitter-related costs not identified in the cost catalog should also identify those expenses in response to item 6 in this question and provide a brief description of the expense.

Question 4: Based on the applicant’s responses to Questions 1-3 in subsection III.B.1 (Transmitters), a table will appear showing the categories of transmitter costs identified by the station. If filing cost estimates, provide the estimated cost for each expense category. If the estimated cost is higher than the predetermined cost estimate or predetermined cost range, provide a justification why the predetermined cost is too low. If a specific expense does not appear in the cost catalog, enter an estimate and provide a explanation for how the estimated cost. When submitting actual cost information, provide an explanation if the actual cost is higher than the estimated cost.

2. Antennas

Question 1: This question contains a list of possible changes the station might have to make to its existing antenna(s) in order to transition to its new channel. Check all that apply.

In answering this question, the applicant should consider the following. In addition to the station’s existing primary antenna, the station may currently have one or more licensed auxiliary antennas for use for backup and/or emergency purposes. These antennas may be able to be retuned to operate on the new channel or may have to be replaced. During its transition to the new channel, the station may also need to use an antenna for interim operations while work is being performed on the primary antenna (e.g., retuning or replacement). The station may have an existing auxiliary or emergency/backup antenna that can be used for interim operations or may have to rent or purchase another antenna for that purpose.

The applicant should answer Question 1 only for antennas currently used by the station for which this form is being filed and that are operational and necessary for that station’s operations. Reimbursement is not available for equipment that is not in working order.

Question 2: For each antenna the station currently uses, describe the purpose for which the antenna is used (e.g., primary, licensed auxiliary, etc.) and indicate if the antenna is owned by the station or a company affiliated with the station (e.g., a group owner) or if the antenna is rented/leased. If the antenna is rented/leased, provide the name and contact information for the owner. In addition, for each antenna, indicate whether it is shared with another station(s) and, if so, provide the facility ID number of the other station(s) with which the antenna is shared. For each antenna provide the name of the manufacturer, the model, the year the antenna was manufactured, and indicate the type of mounting and polarization. For each antenna indicate whether the antenna is a broadband antenna and, if so, indicate the number of stations that can use the antenna (i.e., the antenna’s frequency range). Indicate whether the antenna is in operating condition and whether it is located on, or in close proximity to, an antenna farm.

DTS stations. Stations that indicate they operate with a distributed transmission system (DTS) will be prompted to provide answers to Questions 2, 3, and 4 in this subsection (Antennas) for each site in the system.

Question 3:

1. Retune Existing Antenna. For antennas being retuned, indicate whether a sweep test is needed.

2. New Antenna Costs. For each new antenna purchased, indicate the purpose for which the replacement antenna will be used post-transition. Indicate whether the antenna will be shared with another television station(s) and, if so, provide the facility id number(s) of the other station(s). Provide also the following information about the new antenna: how the antenna is mounted on the tower, polarization, whether the antenna is directional, type, power, manufacturer, and model. If the new antenna is broadband, indicate the frequency range of the antenna and percent of the antenna’s total power capacity that will be used by all stations using the antenna. In addition, provide a justification as to why the station thinks it is reasonable under the circumstances to purchase a new antenna rather than reuse its existing antenna.

3. Other antenna costs.

1. Combiner for Shared Antenna. Indicate whether the station requires a new combiner for a shared broadband antenna or an additional module for an existing combiner. If yes, indicate the number of channels supported by the antenna and the frequency range of the channels capable of using the antenna.

2. Other Antenna Expenses Not Listed. Stations that have antenna-related costs not identified in the cost catalog should identify those costs. When submitting estimated costs, provide a brief description of the cost and an explanation of why the station expects to incur it.

Question 4: Based on the applicant’s responses to Questions 1-3 in subsection III.B.2 (Antennas), a table will appear showing the categories of antenna costs identified by the station. When submitting estimated costs, provide the estimated cost for each expense category. For each category of expense, if the estimated cost is higher than the predetermined cost estimate or range, provide a justification why the predetermined cost estimate is too low. If the category of expense does not appear in the cost catalog, provide a description of how the cost estimate was developed. When submitting actual cost documentation, provide an explanation if the actual cost is higher than the estimated cost.

3. Transmission Line Changes

Question 1: This question contains a list of possible changes the station might have to make to its existing transmission line(s) in order to transition to its new channel. Check all that apply. Applicant will be prompted to answer this question with respect to each antenna identified in response to Section III.B.2 (Antennas), above, to account for the one or more parallel runs of transmission line for each antenna.

The applicant should answer Question 1 only for transmission line required for existing antenna to be retuned or for new antenna. Reimbursement is not available for equipment that is not in working order.

Question 2: For each transmission line the station currently uses, describe the purpose of the antenna served by the line (e.g., primary, licensed auxiliary, etc.) and indicate if the line is owned by the station or a company affiliated with the station (e.g., a group owner) or if the line is rented/leased. If the transmission line is leased, provide the name and contact information for the owner. In addition, for each line, indicate whether it is shared with another television station and, if so, provide the facility ID number of the other station(s) with which the line is shared. Also, for each line provide the name of the manufacturer and indicate the type, diameter, number of parallel runs, length of the line and whether it is in operating condition.

DTS stations. Stations that indicate they operate with a distributed transmission system will be prompted to provide answers to Questions 2, 3, and 4 in this subsection (Transmission Line Changes) for each site and antenna in the system.

Question 3:

1. New transmission line costs. For each new transmission line the station intends to purchase, indicate the purpose for which the associated antenna is used (primary, licensed auxiliary, interim). Indicate also the type of transmission line (flexible foam, flexible air, rigid or waveguide) and the diameter. For rigid line, indicate the segment length. Indicate the number of parallel runs of line required and the length of line in each run. In addition, provide a justification as to why the station thinks it is reasonable under the circumstances to purchase new transmission line rather than reusing its current line.

2. Other expenses. Stations that have costs related to transmission line that are not identified in the cost catalog should identify those costs and provide a brief description of the cost and explain why the station expects to incur it.

Question 4: Based on the applicant’s responses to Questions 1-3 in subsection III.B.3 (Transmission Line Changes), a table will appear showing the categories of costs related to transmission line identified by the station. When submitting estimated costs, provide the total estimated cost (per unit cost times the number of feet of line needed) for each expense category. For each category of expense, if the estimated cost is higher than the predetermined cost estimate or range, provide a justification why the predetermined cost estimate is too low. If the category of expense does not appear in the cost catalog, provide a description of how the cost estimate was developed. When submitting actual cost documentation, provide an explanation if the actual cost is higher than the estimated cost.

4. Tower Equipment and Rigging Costs

Question 1: This question contains a list of possible changes the station might have to make to its primary or auxiliary tower in order to transition to its new channel. Check all that apply.

The applicant should answer Question 1 only for towers currently used by the station for which this form is being filed and that are necessary for that station’s operations. Reimbursement is not available for towers not in use or used only for facilities unrelated to operation of this station.

Question 2: For each tower the station currently uses, indicate whether the tower has a registration number and, if so, provide the Antenna Structure Registration (ASR) number. If the tower has an ASR number, tower height and coordinates, along with the name of the tower owner and date constructed, will be generated from the Commission’s Antenna Structure Registration System.

If the tower does not have an ASR number, provide the tower coordinates (latitude and longitude) and Height Above Ground Level (Height AGL) (in feet or meters). Describe the purpose for which the station uses the tower (e.g., for its primary antenna, auxiliary antenna, distributed transmission system (DTS)) and indicate if the tower is owned by the station or a company affiliated with the station (e.g., a group owner) or if the tower is rented or leased. If the tower is leased, provide the name and contact information for the tower owner. In addition, indicate whether there are other users on the tower and, if so, indicate the kinds of stations and other facilities and provide the Facility ID number for other broadcasters (AM radio, FM radio, other television station). Indicate whether the tower is a complex tower. A tower is considered complex for purposes of this question if it has a candelabra, is located on a building, or located in an area that is difficult to access because of weather or other conditions (terrain constrained).

Provide the year the tower was built. Indicate whether the tower is documented for structural analysis and whether it is currently compliant with Rev G (the “G” revision of the ANSI/TIA-222 standard, “Structural Standards for Antenna Supporting Structures and Antennas”). This standard, effective in 2006, changed the loading and design criteria for both new and existing broadcast towers.

For towers not owned by the station, the station may need to contact the tower owner to obtain some of the information required in this question.

DTS stations. Stations that indicate they operate with a distributed transmission system will be prompted to provide answers to Questions 2, 3, and 4 in this subsection (Tower Equipment and Rigging) for each site in the system.

Question 3:

1. Tower modification costs. For each tower for which the applicant indicated tower modifications are needed, indicate whether a tower study is necessary and, if so, the kind of tower and study needed (undocumented/poorly documented tower, documented tower, tower with candelabra). Also indicate if tower reinforcements are needed and, if so, the degree of reinforcement (minor, major, or serious). The definitions for these tower reinforcement classifications can be found in the cost catalog.

2. Tower construction costs. For each new tower the applicant indicated must be constructed, indicate the height (in feet) of the new tower. In addition, provide a justification as to why the station thinks it is reasonable under the circumstances to build a new tower rather than modifying its existing tower or moving to a different, nearby tower.

3. Tower rigging costs. For each modified or new tower for which rigging costs will be incurred, indicate the kind of tower. Indicate also if a helicopter lift will be required.

4. Other expenses. Stations with tower-related costs that are not listed in the Catalog of Costs should identify the cost and provide a brief description of the cost and an explanation of why the station expects to incur it.

Question 4: Based on the applicant’s responses to Questions 1-3 in subsection III.B.4 (Tower Equipment and Rigging Costs), a table will appear showing the categories of tower costs identified by the station. When submitting estimated costs, provide the total estimated cost for each expense category. For each category of expense, if the estimated cost is higher than the predetermined cost estimate or range, provide a justification why the predetermined cost estimate is too low. If the category of expense does not appear in the cost catalog, provide a description of how the cost estimate was developed. When submitting actual cost documentation, provide an explanation if the actual cost is higher than the estimated cost.

5. Outside Professional Services

Stations may need to obtain professional services from an outside source to complete the station’s channel relocation.

Question 1: Professional Services Costs

1. Professional services costs.

1. Outside project management services. Indicate whether the station expects to use outside project management services. If so, indicate the number of hours of such services the station expects to use and provide an explanation as to why these services are necessary.

2. Outside RF consulting engineer services. Indicate the type of work (e.g., preparing engineering study or completing forms) for which the station will use RF consulting engineer services. With respect to preparation of FCC forms or requests for special temporary authority, indicate the number of such forms and requests the station expects to use outside engineering help to prepare.

DTS stations. Stations that indicate they operate with a distributed transmission system will be prompted to indicate the number of critical facility and terrain shielded sites in the system. Explanations for these site categories can be found in the cost catalog.

3. Attorney and other outside consultant costs. Indicate all outside attorney costs the station may incur. With respect to preparation of FCC forms or requests for special temporary authority, indicate the number of such requests the station expects to need outside attorney help to file. Indicate also if the station expects to engage outside professional services in connection with a NEPA Section 106 environmental review, environmental assessment, ASR modification, or FAA consultation.

4. RF field engineer services. Indicate if the station expects to incur fees for a field study for comprehensive coverage verification or for RF exposure measurements. In addition, indicate if the station expects to need additional field engineering service (e.g., for stations on channel 14 that need to test for interference after installation of the mask filter). If so, indicate the number of days of additional service required and the reason it is required.

2. Other expenses not listed

1. Other professional service expenses not listed. Stations that expect to incur costs related to outside professional services that are not listed should identify the cost and provide a brief description of the cost and an explanation of why the station expects to incur it.

Question 2. Based on the applicant’s responses to Question 1 in subsection III.B.5 (Outside Professional Services), a table will appear showing the categories of costs related to outside professional services identified by the station. When submitting cost estimates, provide the total estimated cost for each expense category. For each category of expense, if the estimated cost is higher than the predetermined cost estimate or range, provide a justification why the predetermined cost estimate is too low. If the category of expense does not appear in the cost catalog, provide a description of how the cost estimate was developed. When submitting actual cost documentation, provide an explanation if the actual cost is higher than the estimated cost.

6. Other Expenses

Question 1. Miscellaneous Expense Costs

1. Miscellaneous costs from Catalog of Costs

1. AM pattern disturbance. Indicate whether the station expects to incur costs related to an impact study to assess the potential impact of tower construction or modification on AM radio stations. Also indicate if the station expects to have to install detuning apparatus or adjust existing detuning apparatus to remedy any interference to AM stations.

2. Facility Expenses. Indicate if the station has other expenses related to interim facilities or operation of a DTS station(s). Also indicate if the station will incur expenses related to notification of nearby medical facilities of their channel change.

3. Permit costs. Indicate if the station expects to have to obtain permits in connection with its channel relocation. Check all that apply.

4. Other miscellaneous expenses. Indicate if the station expects to incur costs identified in this section. Check all that apply.

2. Other expenses not listed in the Catalog of Costs

1. Other miscellaneous expenses not listed. Stations that expect to incur costs not listed in the cost catalog or elsewhere on this form should identify the cost and provide a brief description of the cost and an explanation of why the station expects to incur it.

Question 2. Based on the applicant’s responses to Question 1 in subsection III.B.6 (Other Expenses), a table will appear showing the categories of costs identified by the station. When submitting cost estimates, provide the total estimated cost for each expense category. For each category of expense, if the estimated cost is higher than the predetermined cost estimate or range, provide a justification why the predetermined cost estimate is too low. If the category of expense does not appear in the cost catalog, provide a description of how the cost estimate was developed. When submitting actual cost documentation, provide an explanation if the actual cost is higher than the estimated cost.

SECTION V – MVPD INFORMATION AND TRANSITION PLAN

A – MVPD Information

Question 1: The form will pre-fill information currently in the FCC’s database regarding the MVPD for which this form is being filed.

Question 2: Provide the following information for each television broadcast station carried by the MVPD that is changing channel as a result of the incentive auction: the station call sign, licensee name, and the nature of the channel change (see explanation below). In addition, for each station identify the PSID or receive site at which the station is received.

In answering this question, note that the MVPDs are eligible for reimbursement costs reasonably incurred in order to continue to carry the signal of: (1) a full power or class A television station that is involuntarily reassigned in the repacking process from UHF-to-UHF, VHF-to-VHF, or VHF-to-UHF; (2) channel sharer stations that are involuntarily reassigned in the repacking process; (3) a full power or class A broadcast television licensee that voluntarily relinquishes spectrum usage rights with respect to a UHF channel in return for receiving spectrum usage rights with respect to a VHF channel; (4) a full power or class A television station that voluntarily relinquishes spectrum usage rights with respect to a high VHF channel in return for receiving spectrum usage rights with respect to a low VHF channel; and (5) a full power or class A broadcast television licensee that voluntarily relinquishes spectrum usage rights to share a television channel with another licensee. All stations making a channel change (voluntary or involuntary) that results from the incentive auction will be listed in the Channel Reassignment PN. In addition, a transitioning station has an obligation to provide notice to an MVPD prior to changing channels or terminating operations (see Incentive Auction Order, para. 596).

The form will display a list of the stations nationwide that fall into categories 1-5. MVPDs will indicate each PSID(s) or receive site at which the channel(s) is received.

B – MVPD Estimated or Actual Transition Expenses

This section should be answered separately for each PSID or receive site identified in Section IV.A (MVPD Information) above. At the end of this section, the applicant will be prompted to repeat the section for an additional PSID(s) or receive site(s) if necessary.

Question 1. For each PSID/receive site identified in Section IV.A. (MVPD Information) and for each channel at the PSID/receive site for which the MVPD expects to incur transition costs, provide the following information.

1. PSID or Receive Site. Identify the PSID number for which the following questions are being answered. If there is no PSIP number, identify the receive site and provide the site address.

1. Channel specific costs.

Coaxial cable. For each PSID or receive site, indicate whether the MVPD expects to purchase coaxial cable and, if so, provide the number of feet of cable it expects to purchase.

Antenna. For each PSID or receive site, indicate whether the MVPD expects to install a new receive antenna and, if so, the kind of antenna. In addition, MVPDs that expect to purchase a new antenna must provide a justification as to why the station thinks it is reasonable under the circumstances to purchase a new antenna rather than retuning its current antenna.

Structural or capacity augments for towers. For each PSID or receive site, indicate whether the MVPD expects to make changes to an existing tower to meet new tower loading requirements as a result of the installation of new equipment.

Tower rigging. For each PSID or receive site, indicate whether the MVPD will incur tower rigging costs.

RF Processing Equipment. For each PSID or receive site, indicate if the MVPD will incur costs for RF processing equipment.

Other channel specific costs. For each PSID or receive site, MVPDs that expect to incur channel specific costs that are not listed in the cost catalog should identify the cost and provide a brief description of the cost and an explanation of why the station expects to incur it.

2. Outside professional services.

Structural study of tower capacity. For each PSID or receive site, indicate if the MVPD expects to engage outside professional services to perform a structural study of tower capacity.

Engineering study. For each PSID or receive site, indicate if the MVPD expects to engage outside professional services to conduct a structural study of tower capacity or an engineering study (e.g., to estimate the receive strength of new channel assignments and/or the capabilities of current equipment).

Other professional services costs not listed. For each PSID or receive site, MVPDs that expect to incur costs that are not listed in the cost catalog should identify the cost and provide a brief description of the cost and an explanation of why the station expects to incur it.

Question 2. Based on the applicant’s responses to Question 1, a table will appear showing the categories of costs identified by the MVPD for this PSID/receive site and channels received at that location. When submitting cost estimates, provide the total estimated cost for each expense category. For each category of expense, if the estimated cost is higher than the predetermined cost estimate or range, provide a justification why the predetermined cost estimate is too low. If the category of expense does not appear in the cost catalog, provide a description of how the cost estimate was developed. When submitting actual cost information, provide an explanation if the actual cost is higher than the estimated cost.

Section VI – Certifications

1. With Submission of Estimated Expenses

Broadcasters and MVPDs filing estimated costs should read all certifications in this section before signing this form.

2. With Submission of Actual Cost Documentation

Broadcasters and MVPDs submitting actual cost documentation should read all certifications in this section before signing this form.

3. With Submission of Final Allocation or Accounting Information

Broadcasters and MVPDs filing final allocation or accounting information should read all certifications in this section before signing this form.

D. With Submission of LPTV/TV Translator/FM Eligibility Certification

LPTV/TV Translator licensees, full-service FM station licensees, LPFM licensees, and FM translator licensees should read all certifications in this section before signing this form.

11