Initial Contact 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

NOAA Private Remote Sensing License
Initial Contact Form
Privacy Act Statement
Authority: The collection of this information is authorized under 5 U.S.C. § 301, Departmental regulations, which
authorizes the operations of an executive agency, including the creation, custodianship, maintenance and distribution
of records.
Purpose: NOAA collects this information in order to determine any applicable requirements for your remote sensing
space system under the National and Commercial Space Programs Act of 2010 (51 U.S.C. § 60101, et seq.) and
regulations, 15 CFR Part 960.
NOAA Routine Uses: NOAA will use this information to assess whether a full license application would be required
for a proposed satellite system. Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C.
Section 552a) to be shared among CRSRA staff for work-related purposes. Disclosure of this information is also
subject to all of the published routine uses as identified in the Privacy Act System of Records Notice
Commerce/NOAA-11(http://www.osec.doc.gov/opog/PrivacyAct/SORNs/noaa-11.html), Contact Information for
Members of the Public Requesting or Providing Information Related to NOAA’s Mission.
Disclosure: Furnishing this information is voluntary; however, failure to provide accurate information may delay or
prevent the individual from obtaining a determination on applicable requirements under the law and regulations.

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 3 hours
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 necessary to verify that all facts in the license remain
true Send comments regarding this burden estimate or any other aspect of this information collection, including
suggestions for reducing this burden to 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
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CLCSS ICF Submission Form - Home

Initial Contact Form


Email



First Name



Last Name

Position title



What entity or organization are you submitting this contact form on behalf of?



What type of entity or organization is this?
Other



Explanation of other



Address

Would you like another person to be copied on correspondence related to this contact form?
Yes


Additional Email(s) (comma-separated)

What is the name of the remote sensing instrument or spacecraft as it will be provided in regulatory filings and
registrations made with the U.S. Government and launch provider?


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

CLCSS ICF Submission Form - Home

Will the instrument or spacecraft orbit the Earth at least once at any point during its mission?
-- None --



Is any instrument on the spacecraft capable of collecting data of Earth's surface?
Yes

Please list each instrument capable of collecting data of the Earth or man-made objects in space. Include details
such as instrument type and an overview of the instrument capabilities.




Will the mission include collecting data of man-made objects in space?
-- None --



What are the objectives of the mission?

When do you anticipate the system will launch?
Quarter
-- None --

Year
-- None --

What entity or organization will have decision-making authority over the functioning of the remote sensing
instrument(s), meaning the authority to decide what data to collect?


Will any other entity own (have title to) or control (execute commands or directly interact with) the remote sensing
instrument(s) or spacecraft?



Will the mission control (mission operations) center be located within the U.S. or its territories?

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CLCSS ICF Submission Form - Home

-- None --

Submit

Required information
Email

First Name

Last Name
What entity or organization
Explanation of other
Address
Additional Email(s) (comma
What is the name of the rem
Will the instrument or spac
Please list each instrument
Will the mission include col
What are the objectives of t
What entity or organization
Will the mission control (m

https://nsdesk.servicenowservices.com/clcss?id=sc_cat_item_record_prod2

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