Form FCC Form 470 FCC Form 470 Description of Services Requested and Certification Form

OMB Control No. 3060-1323 Estimated Time per Response

[Month] 2024 4 hours

Not Yet Approved by OMB

Schools and Libraries Cybersecurity Pilot Program

Description of Services Requested and Certification Form 470 (using FCC Form 470 information collection requirements approved pursuant to OMB Control No. 3060-0806)

(Note: This is a representative description of the information to be collected via the online portal and is not intended to be a visual representation of what each participant will see. Where possible, information already pre-filed in the system portal can be carried forward and auto-populated into the form.)

Item Number	Field Description	Purpose/Instructions
1	Participant’s Form Nickname	To create unique identifier for this submission, the user simply enters a nickname (e.g., 2016 FY ABC School Form 470).
2	FCC Form 470 Application Number	Auto-generated by the system: This is an Administrator-assigned unique identifier for this submission.
3	Participant Name	This is the name of the organization submitting this form—school, school district, library (outlet/branch or system), or a consortium of those entities (schools, libraries, or schools and libraries). If this information has already been entered into the user’s profile, it will be pre-populated into this submission.
4	Pilot Program Year	Auto-generated by the system based on the applicable year of the Schools and Libraries Cybersecurity Pilot Program: This is the Pilot Program year for which equipment and/or services are sought.
5	Entity Number	Pre-populated by the system: This is the Unique identifier assigned by the Administrator to the organization listed in Participant Name.
6	FCC Registration Number	This is the unique FCC identifier for the organization listed as the participant. If this information has already been entered into the user’s profile, it will be pre-populated into this submission.
7	Mailing Address	This is the mailing address for the participant. If this information has already been entered into the user’s profile, it will be pre-populated into this submission.
8	Participant Type	User is required to pick whether the participant is an individual school, school district, library, consortium, or statewide application.
9	Type of Eligible Entities that Will Receive Services: If Statewide Application	If the user chooses “statewide application” in Item 8, the user will be required to select which state and whether the application includes public schools, and/or non-public schools, and/or libraries.
10	Entity Attributes	User must select from a list of all that apply. Choices include private, public, charter, Tribal, head start, and state agency.
11	Number of Eligible Sites for Which Equipment or Services are Sought	User must provide the number of eligible sites for which equipment or services are being sought.
12	Contact Person Name	User must provide the name of the person who should be contacted with questions about this application. If this information has already been entered into the user’s profile, it will be pre-populated into this submission.
13	Contact Person Mailing Address	User must provide the mailing address of the person who should be contacted with questions about this application. If this information has already been entered into the user’s profile, it will be pre-populated into this submission.
14	Contact Person Telephone Number	User must provide the telephone number of the person who should be contacted with questions about this application. If this information has already been entered into the user’s profile, it will be pre-populated into this submission.
15	Contact Person Email Address	User must provide the email address of the person who should be contacted with questions about this application. If this information has already been entered into the user’s profile, it will be pre-populated into this submission.
16	Consultant Information	If the participant uses a consultant to submit its application, the user must provide the name of the consulting company, the consulting company’s registration number, the consulting company’s telephone number, the consulting company’s email address, the name of the consultant(s) representing the participant, the telephone number of the consultant(s), the email address of the consultant(s), and the physical address of the consultant(s). If this information has already been entered into the user’s profile, it will be pre-populated into this submission.
17	Cybersecurity Equipment and Services —Equipment and Service Description	User is required to provide a description of the cybersecurity equipment and services it wishes to purchase. Participant will need to provide enough detail for bidders to provide responsive bids.
18	Cybersecurity Equipment and Services —Quantity and/or Capacity	User is required to provide a description of the quantity, capacity needs, and amounts of requested cybersecurity equipment and services. Participant will need to provide enough detail for bidders to provide responsive bids.
19	Indicate whether a Request for Proposal (RFP) will be released for the requested Cybersecurity Equipment and Services	User must indicate whether it will be using an RFP. If an RFP is used, it must be attached so that it can be “released” with the posting of the Form 470.
20	Technical Contact Person	User must provide contact information for the appropriate person to provide additional technical details regarding the equipment and services sought.
21	State, Tribal, or Local Procurement Restrictions	User must provide a description of any applicable state, Tribal, or local procurement restrictions or indicate that no state, Tribal, or local procurement/competitive bidding requirements apply to this procurement.
22	Recipient(s) of Service	User must list the Recipients of Service that will be receiving or using the requested equipment or services based on this application.
23	Certifications: “I am authorized to submit this application on behalf of the above-named participant in the Schools and Libraries Cybersecurity Pilot Program and that based on information known to me or provided to me by employees responsible for the data being submitted, I hereby certify that the data set forth in this form has been examined and is true, accurate, and complete. I acknowledge that any false statement on this application or on other documents submitted by this participant can be punished by fine or forfeiture under the Communications Act (47 U.S.C. §§ 502, 503(b)), or fine or imprisonment under Title 18 of the United States Code (18 U.S.C. § 1001), or can lead to liability under the False Claims Act (31 U.S.C. §§ 3729–3733).”	The authorized person will be required to make the following certifications to be able to submit this FCC Form 470. The certifications are necessary to ensure the participant is compliant with the Schools and Libraries Cybersecurity Pilot Program rules and to protect the Program from waste, fraud, and abuse.
24	“In addition to the foregoing, this participant is in compliance with the rules and orders governing the Schools and Libraries Cybersecurity Pilot Program, and I acknowledge that failure to be in compliance and remain in compliance with those rules and orders may result in the denial of funding, cancellation of funding commitments, and/or recoupment of past disbursements. I acknowledge that failure to comply with the rules and orders governing the Schools and Libraries Cybersecurity Pilot Program could result in civil or criminal prosecution by law enforcement authorities.”	See number 23 above.
25	“By signing this application, I certify that the information contained in this form is true, complete, and accurate. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise. (U.S. Code Title 18, §§ 1001, 286–287, and 1341, and Title 31, §§ 3729–3730 and 3801–3812).”	See number 23 above.
26	The schools meet the statutory definition of “elementary school” or “secondary school” as defined in § 54.2000, do not operate as for-profit businesses, and do not have endowments exceeding $50,000,000.	See number 23 above.
27	Libraries or library consortia eligible for assistance from a State library administrative agency under the Library Services and Technology Act of 1996 do not operate as for-profit businesses and, except for the limited case of Tribal college or university libraries, have budgets that are completely separate from any school (including, but not limited to, elementary and secondary schools, colleges, and universities).	See number 23 above.
28	The services and/or equipment that the school, library, or consortium purchases at discounts will not be sold, resold, or transferred in consideration for money or any other thing of value, except as allowed by § 54.2003(b).	See number 23 above.
29	The school(s) and/or library(ies) listed on this FCC Form 470 will not accept anything of value, other than services and equipment sought by means of this form, from the service provider, or any representatives or agent thereof, or any consultant in connection with this request for services.	See number 23 above.
30	All bids submitted for eligible equipment and services will be carefully considered, with price being the primary factor, and the bid selected will be for the most cost-effective service offering consistent with paragraph (e) of this section.	See number 23 above.
31	The school, library, or consortium acknowledges that support under the Schools and Libraries Cybersecurity Pilot Program is conditional upon the school(s) and/or library(ies) securing access, separately or through this program, to all of the resources necessary to effectively use the requested equipment and services. The school, library, or consortium recognizes that some of the aforementioned resources are not eligible for support and certifies that it has considered what financial resources should be available to cover these costs.	See number 23 above.
32	I will retain required documents for a period of at least 10 years (or whatever retention period is required by the rules in effect at the time of this certification) after the later of the last day of the applicable Pilot Program year or the service delivery deadline for the associated funding request. I also certify that I will retain all documents necessary to demonstrate compliance with the statute (47 U.S.C. § 254) and Commission rules regarding the form for, receipt of, and delivery of equipment and services receiving Schools and Libraries Cybersecurity Pilot Program discounts. I acknowledge that I may be audited pursuant to participation in the Pilot Program.	See number 23 above.
33	I certify that the equipment and services that the participant purchases at discounts will be used primarily for educational purposes and will not be sold, resold, or transferred in consideration for money or any other thing of value, except as permitted by the Commission’s rules at 47 C.F.R. § 54.2003(b). Additionally, I certify that the entity or entities listed on this form will not accept anything of value or a promise of anything of value, other than services and equipment sought by means of this form, from the service provider, or any representative or agent thereof, or any consultant in connection with this request for services.	See number 23 above.
34	I acknowledge that support under this Pilot Program is conditional upon the school(s) and/or library(ies) I represent securing access, separately or through this program, to all of the resources necessary to effectively use the requested equipment and services. I recognize that some of the aforementioned resources are not eligible for support. I certify that I have considered what financial resources should be available to cover these costs.	See number 23 above.
35	I certify that I have reviewed all applicable Commission, state, Tribal, and local procurement/competitive bidding requirements and that the participant will comply with all applicable requirements.	See number 23 above.
36	Signature of Authorized Person	The form must be signed by an authorized person.
37	Date Signed	Auto generated by system.
38	Name of Authorized Person	This is the name of the authorized person signing the form.
39	Title or Position of Authorized Person	This is the title or position of the authorized person signing the form.
40	Physical or mailing address of Authorized Person	This is the address (can be physical address or mailing address) of the authorized person signing the form.
41	Telephone Number of Authorized Person	This is the telephone number of the authorized person signing the form.
42	Email address of Authorized Person	This is the email address of the authorized person signing the form.
43	Name of Authorized Person’s Employer	This is the name of the employer of the authorized person signing the form.

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