NTIA Form # DTV-4 | OMB Control No. 0660-0022 Expiration Date: 09/30/2009 |
NTIA REGISTRATION |
REGISTRATION INFORMATION | INSTRUCTIONS |
Facility Number | | | | |
| Enter the FCC Facility ID # of the first station for which funding is requested. |
NTIA will pre-fill some of the following information from the FCC's files for the station you entered.
If information does not appear, enter another Facility ID licensed to you. Information is based upon FCC data: http://www.fcc.gov/fcc-bin/audio/tvq.html
Correct, if necessary, the pre-filled information and explain the reason for the change. |
| Create User ID. |
| Create Password. ( 8 to 16 characters) |
| Confirm Password. |
| Select a security question. |
| Enter the answer to the security question above. |
| Enter the name of the applicant (licensee).
This should be the same name that appears on the FCC licenses for your stations(s).
If necessary, check box and explain the reason for licensee name change
before entering a new name |
| The address should be the same mailing address as in the FCC files.
If necessary, check box and explain the reason for the address change
before entering a new address |
| All applicants must provide a Dun and Bradstreet Data Universal Numbering
System (DUNS) number when applying for Federal grants.
The CFDA # for this Program is 11.554.
Organizations can receive
a DUNS number at no cost in 5-10 minutes by calling the dedicated toll-free DUNS Number request line
1-866-705-5711 or via the Internet (1 business day) at: http://www.dunandbradstreet.com |
| Enter the applicant's Employer Identification Number assigned by the IRS.
(or Social Security Number if licensee is an individual) |
| Name of the person who is authorized to apply for NTIA funding. |
| Title of the authorized person. |
| Phone number of the person who is authorized to apply for NTIA funding. |
| Email of the authorized person. |
| Enter the Congressional District of the applicant's headquarters
(this can only be one number). If there is only one Congressional District in the State/Territory,
enter "1"
To find your congressional district click this link: http://fastfacts.census.gov/home/cws/main.html
Enter your street address and 5 digit zip code in the appropriate boxes. |
| This question refers to the licensee, not the contact person. |
* Is the Applicant a non-profit corporation organized under IRS 501(c) [excluding (c)(4)]? | Applications which are non-profit corporations organized under IRS 501(c)
[excluding (c)(4)] will receive priority consideration during the period October 29, 2007 - January 31, 2008. |
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