Federal Communications Commission - FCC Form 730
 

1. Applicant

Name:

 

 Address:



Telephone Number:
2. U.S. Service Center:

Name:

 

 Address:



Telephone Number:
3. Manufacturer:

Name:

 

 Address:



Telephone Number:
4. Party to Get Grant:

Name:

 

 Address:



Telephone Number:
ID and Registration Numbers:

5. Applicant's Electronic Data File ID:

6. Applicant's FCC ID:

 7. Manufacturer's FCC ID:

8. Current Registration:

 
9. Type of Applicant: 10. Registration Class:

a. Manufacturer (M)
b. Vendor (V)
c. User (C)

a. Terminal (T)
b. System (S)
c. Protective Circuit (P)
 
11. Type of Application:

a. Original (1)
b. Modification (2)
c. Notice (3)
 

 d. Short Form (4)
e. Blanket Modification (5)
f.  Registration (6)
g. Other (specify):
12. Equipment Code:
13. Equipment Description:

 
14. Purpose or Reason for Application, if this is a Notice, Modification or Re-registration Application:

 
15.  List Trade Names and Model Numbers.  Use Exhibit C if more space is required:
Trade Name:

Model:

 
16.  Does equipment use attested network connectors?: Yes  No  (see instructions)

17. (a) Type Supplemental Protection: (b) Voltage rating: (c) Network Signaling Code:

 
18.  If this is a notice application and original application was filed more than 6 months previously, please provide Continuing Compliance Verification Date:
 
LOOP-START CONSUMER PRODUCTS (Telephones, Answering Machines, FAX, Data Modems, etc.)

19. (a) AC REN: (b) DC REN: (c) HAC:  (d) WT Sec. Code:

20. (a) USOC:  (b) Repeat Dials: (c) No. Attempts:

21. Fax Branding Compliance?

MODEMS (Data, FAX, Multimedia)

22. (a) Physical Construction: 

23. Max Sync Speed(s):

24. (a) Protocols: Standard/Proprietary: (b) Data Compression Method:

25. Error Correction Method: 26. USOC Jacks:

27. JM8 Jack? Yes  No  28. Fax Branding Compliance?

 
29. For all applications: Type of SURGE: 30. For telephones: RFI IMMUNITY:

31. For telephones & answering machines: benitzTAP IMMUNITY:

 
COIN PHONE CREDIT CARD DEVICES AND TELEMARKETING EQUIPMENT

Complete Sections 19-20 or 29-32 as applicable. 
32. Location of Label?

Coin & Credit Card Devices:
33. Equal Access Compliance attached?

34. Telemarketing equipment Compliance attached?

 
ANALOG SYSTEMS (Key, Hybrid, PBX requiring 3 or more lines to C.O. lines; DIGITAL EQUIPMENT (DD, DE, DX, XD);
ANALOG SYSTEMS with digital ports.

Check the appropriate column

 YES NO
35. DID and NANP compliance statements attached?
36. Equal Access compliance statement attached?
37. E911 station location compliance statement attached?
38. SYSTEM PORT IDENTIFICATION, FACILITY, ANSWER SUPERVISION AND SERVICE ORDER CODES (1)
Registration Status (2) LS/GS/DID 1/F FIC (3) Mfrs Port ID (4) AC & DC REN (5,6, or DID SOC 12) Network Jacks (7)




















ANALOG PL I/F FIC (8) SERVICE ORDER CODE (9)








DIGITAL 1/F FIC (10) SERVICE ORDER CODE (11.12)








39. CONTENTS OF REGISTRATION "ENVELOPE" SYSTEM CONFIGURATIONS
TRADE NAME MODEL NO. # CO PORTS # STATION PORTS GENERIC PORTS (generic Ports can be used as either CO or Station Port)




















TYPE OF STATIONS
STANDARD (check if applicable) PROPRIETARY (check if applicable) CORDLESS (Insert frequency bands (46/49 MHz, 902-928 MHz, or other) HAC? WT SEC CODE?




















ANCILLARY EQUIPMENT USED IN REGISTRATION "ENVELOPE"

NAME OF ANCILLARY EQUIPMENT (Consoles, Telephone, External Power Supplies, Modems, etc.)

 Model Number

40.  Check the left column to indicate exhibits attached to this application
Exhibit A - Letter explaining purpose of application.
Exhibit B - Letter from grantee to applicant giving permission to register.
Exhibit C - Long list of trade names and model numbers.
Exhibit D - Equipment description.
Exhibit E - Technical requirements.
Exhibit F - Equipment Evaluation.
Exhibit G-1 - Summary of Quality Control Program.
Exhibit G-2 - Continuing Compliance Program.
Exhibit H - Label
Exhibit J - Customer Instructions.

 

41.  Certification of Person Responsible for Preparing Engineering Information

I certify that I am the technically qualified person responsible for preparation of the engineering information contained in this Application, that I am familiar with Part 68 of the Commission's Rules, that I have either prepared or reviewed the engineering information submitted in this Application and that it is complete and accurate to the best of my knowledge and furthermore, I affirm that the equipment described herein complies with Part 68.  I have notified the Applicant of the Commission's requirements for on-going compliance and quality assurance specified in Section 68.200(d) and for information to be supplied users (Exhibit J).
Date:

Name:

Name and Address of Firm:

42. Part 68 Test Procedures Filed with FCC? Yes  No

If "yes", give date:  Class:

43. Certification of Applicant

By checking yes, the applicant certifies that, in the case of an individual applicant, he or she is not subject to a denial of federal benefits that includes FCC benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. Section 862, or, in the case of a non-individual applicant (e.g., corporation, partnership or other unincorporated association), no party to the application is subject to a denial of federal benefit that includes FCC benefits pursuant to that Section.  For the definition of a "party" for these purposes, see 47 C.F.R. Section 1.2002(b).

I, individually and for the Applicant, certify that the statements made in this Application are true, complete and correct to the best of my knowledge, and are made in good faith.  I also certify that the equipment represented by this Application will continue to comply with Part 68 for its intended service life, and that Exhibits G1 and G2 represent the policies of the Applicant and will be followed for all items manufactured and distributed under the provisions of Part 68, that the labels described in Exhibit H will be affixed to each item and the information described in Exhibit J will be provided with each item manufactured or distributed by the Applicant.

Date: Name: Telephone No.: