FCC Form 621 FEDERAL COMMUNICATIONS COMMISSION Information and Instructions Approved by OMB 3060 -1039 Est. Avg. Burden Per Response: .5 to 10 Hrs FCC Wireless Telecommunications Bureau Collocation ("CO") Submission Packet NOTICE TO INDIVIDUALS REQUIRED BY THE PRIVACY ACT OF 1974 AND THE PAPERWORK REDUCTION ACT OF 1995 We have estimated that each response to this collection of information will take on average 5 hours. 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 (3060-1039). 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 3060-1039. 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 you provide to determine whether approving this application is in the public interest. If we believe there may be a violation or potential violation of a statute, FCC 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; or (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. All parties and entities doing business with the Commission must obtain a unique identifying number called the FCC Registration Number (FRN) and supply it when doing business with the Commission. Failure to provide the FRN may delay the processing of the application. This requirement is to facilitate compliance with the Debt Collection Improvement Act of 1996 (DCIA). The FRN can be obtained electronically from the FCC's website at http://www.fcc.gov or by manually submitting FCC Form 160. FCC Form 160 is available from the FCC's web site at http://www.fcc.gov/formpage.html, by calling the FCC's Forms Distribution Center at (800) 418-FORM (3676), or from the FCC's Fax Information System by dialing (202) 418-0177. This notice is required by the Privacy Act of 1974, Public Law 93-579, December 31, 1974, 5 U.S.C. Section 552a (e)(3), and the Paperwork Reduction Act of 1995, Public Law 104-13, October 1, 1995, 44 U.S.C. 3507. FCC Form 621 ­ Instructions May 2014 - Page 1 American LegalNet, Inc. www.FormsWorkFlow.com General Instructions Purpose of Form FCC Form 621 is the CO Submission Packet is to be completed by or on behalf of Applicants who wish to collocate an antenna or antennas on an existing communications tower or non-tower structure by or for the use of licensees of the Federal Communications Commission ("FCC")1. The Packet (including Form CO and attachments) is to be submitted to the State Historic Preservation Office ("SHPO") or to the Tribal Historic Preservation Office ("THPO"), as appropriate, before any construction or other installation activities on the site begin. Failure to provide the Submission Packet and complete the review process under Section 106 of the National Historic Preservation Act ("NHPA")2 prior to beginning construction or other installation activities may violate Section 110(k) of the NHPA and the Commission's rules. The instructions below should be read in conjunction with, and not as a substitute for, the "Nationwide Programmatic Agreement for Review of Effects on Historic Properties for Certain Undertakings Approved by the Federal Communications Commission," dated September 2004, ("Nationwide Agreement"), the "Nationwide Programmatic Agreement for the Collocation of Wireless Antennas" ("Collocation Agreement")3, and the relevant rules of the FCC (47 C.F.R. §§ 1.1301-1.1319) and the Advisory Council on Historic Preservation ("ACHP") (36 C.F.R. Part 800)4 Exclusions and Scope of Use The CO Submission Packet should be submitted only for those collocations that are subject to Section 106 review. The CO Submission Packet should not be submitted for collocations that have been excluded from Section 106 Review by the Collocation Agreement or the Nationwide Programmatic Agreement. Where a collocation is to be completed but no submission will be made to a SHPO or THPO due to the applicability of one or more exclusions, the Applicant should retain in its files documentation of the basis for each exclusion should a question arise as to the Applicant's compliance with Section 106. The CO Submission Packet is to be used only for the collocation of an antenna or antennas on an existing communications tower or a non-tower structure. New tower constructions that are subject to Section 106 review should be submitted using the New Tower ("NT") Submission Packet (FCC Form 620). Electronic Filers Information about online filing of Form 621 is available from the Wireless Telecommunications Bureau website at http://wireless.fcc.gov/outreach/index.htm?job=tower_notification. Applicants filing electronically should follow procedures contained in online help files. For technical assistance with filing electronically, contact the FCC at (877) 480-3201. In instances where the Applicant files electronically and needs to include an exhibit(s) with the application and cannot transmit that exhibit(s) to the FCC electronically, the Applicant may mail exhibits to the following address: Federal Communications Commission Application Exhibit 1270 Fairfield Road Gettysburg, PA 17325-7245 Hand-deliveries and messenger-deliveries should be delivered to Federal Communications Commission, 1280 Fairfield Road, Gettysburg, PA 17325. Each exhibit should be clearly labeled with the Applicant's name, the 10-digit file number assigned to the application at the time of submission, and the type of exhib