Certificate Of Compliance With The Radio Provisions {806}

American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com OMB Control Number 30600228 Notice to Individuals Required by the Privacy Act of 1974 and the Paperwork Reduction Act of 1995 The solicitation of information requested in this form is authorized by the Communications Act of 1934, as amended. The Commission will use FCClicensed technicians to conduct ship inspections and determine if the radio installation is in compliance with the requirements of the Communications Act of 1934, as amended. All information provided in this form, as well as the form itself, will be available for public inspection. Public reporting burden for this collection of information is estimated to average 10 minutes per response. 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, Office of Managing Director, AMDPERM, Washington, DC 20554, Paperwork Reduction Act Project (30600228). We will also accept your PRA comments via the Internet if you send an email to PRA@fcc.gov. Please DO NOT SEND COMPLETED 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 and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 30600228. THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93579, DECEMBER 31, 1974, 5 U.S.C. SECTION 552a(e)(3) AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 10413, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507. FCC Form 806 ­ Page 3 August 2012 American LegalNet, Inc. www.FormsWorkFlow.com