Anomaly Notification Form

OMB Control Number: 0648-0174

Expiration Date: XX/XX/20XX

CUI//PRVCY/PROPIN//FEDCON

when filled in

Licensee Exempt from CUI Handling and Dissemination Restrictions

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration

Office of Space Commerce
Commercial Remote Sensing Regulatory Affairs
Washington, D.C. 20230

Anomaly Notification Form

Pursuant to 15 C.F.R. § 960.8(e)(3), each licensee must “Notify the Secretary in writing of each of the following events, no later than seven days after the event: The detection of an anomaly.” Anomaly means “an unexpected event or abnormal characteristic affecting the operations of a system that could indicate a significant technical malfunction or security threat. Anomalies include any significant deviation from the orbit and data collection characteristics of the system.” See 15 C.F.R. § 960.4.

Instructions

This form may be filled out in multiple formats, including by email in Word document format by replacing blue guidance text with your responses using blue text or by filling out an electronic form associated with holding an account. If responding by Word document:

• Please remove all guidance text prior to submission.

• If you wish to submit the application in Word document format through encrypted communications, please email crsra@noaa.gov for instructions.

If filling out the form electronically in an information system, confirmation of accessing a U.S. Government system may be required.

Any questions regarding this form should be directed to crsra@noaa.gov.

Privacy Act Statement

PRIVACY ACT STATEMENT: The authorities for the collection of the following information and the intended uses of the information are detailed online at the following link: CRSRA Privacy Act Statement. You may request a copy of the linked Privacy Act Statement by emailing crsra@noaa.gov.

• Confirmation of having read the Privacy Act Statement is required if filling out a form in electronic format.

Notification Content

1. Operator name: (conditional)

2. System: (required)

In the electronic user-account format, the operator will be able to select from their licensed systems. In the Word format, the operator is required to enter the name of the relevant system as it exists on the license.

3. Internal satellite designator, if a part of a multi-spacecraft system: (required)

This field requires the operator to input their designator (“tail number” or name) for the specific satellite suffering the anomaly.

4. Date upon which anomaly was first detected: (required)

5. Has this anomaly, or a related anomaly, been previously reported? (required)

Yes/No

6. When was this anomaly previously reported? (required if answer to 5 is Yes)

7. Description of the anomaly, including: (required)

1. spacecraft subsystem(s) affected,

2. impact to system operations,

3. impact to imaging operations,

4. impact to unenhanced data collection capabilities,

5. resultant deviation from orbital characteristics of the system,

6. known or suspected cause.

8. What is the state of anomaly resolution activities? (required)

Resolved/Ongoing

9. Are there potential long-term mission impacts resulting from this anomaly? (required)

Yes/No

10. Please describe the potential long-term mission impacts. (required if answer to 9 is Yes)

11. If you would like to provide additional information or attachments regarding the anomaly, please do so here. (optional)

12. Do you require a license modification or other licensing action as a result of the anomaly? (required)

Yes/No

If operator selects “Yes” in the user account electronic format, upon submission of the form, a modification request form will be initiated.

PRA Burden Statement:

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0648-0174. Without this approval, we could not conduct this information collection. Public reporting for this information collection is estimated to be approximately 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are mandatory pursuant to 15 C.F.R § 960. This information is used by NOAA to record the details of an anomaly from a licensed remote sensing system. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the  the NOAA, 1401 Constitution Ave., NW Washington, D.C. 20230, Attn: CRSRA Director, Dr. Sarah Brothers, sarah.brothers@noaa.gov.

CUI//PRVCY/PROPIN//FEDCON

when filled in

Licensee Exempt from CUI Handling and Dissemination Restrictions