All previous editions obsolete. Form 2100, Schedule 350 Instructions

 May 2019

Federal Communications Commission

Washington, DC 20554

Approved by OMB

OMB Control Number 3060-0404

Estimated Time per Response – 1 Hour

Instructions – Form 2100, Schedule 350 - FM TRANSLATOR

OR FM BOOSTER STATION LICENSE APPLICATION

The following instructions track the FM Translator and FM Booster Station License Application in LMS:

GENERAL INSTRUCTIONS

FCC Schedule 350, is to be used in all cases when applying for an FM translator or FM booster broadcast station license. 

FCC Rules. This application form makes many references to FCC rules. Applicants should have on hand and be familiar 

with current broadcast rules in Title 47 of the Code of Federal Regulations (CFR):

(1) Part 0 "Commission Organization"

(2) Part 1 "Practice and Procedure"

(3) Part 73 "Radio Broadcast Services"

(4) Part 74 "Experimental Radio, Auxiliary, Special Broadcast, and Other Program Distributional Services"

FCC Rules may be purchased from the Government Publishing Office. Current prices and purchasing information may be 

obtained from the GPO Bookstore Website at https://bookstore.gpo.gov/. An up-to-date electronic version of Title 47 of the 

CFR may be accessed at https://www.ecfr.gov/cgi-bin/textidx?SID=0970bd71b3f8da40f9fc92f01b613dfd&mc=true&tpl=/ecfrbrowse/Title47/47tab_02.tpl.

Electronic Filing of Application Forms. Electronic filing of Schedule 350 is mandatory. See

https://enterpriseefiling.fcc.gov/dataentry/login.html. Similarly, any amendment to a pending FCC Schedule 350

application must be filed electronically. The amendment should contain the following information to identify the 

associated application:

(1) Applicant's name

(2) Facility ID#

(2) Call letters or specify "NEW" station

(3) Channel number 

(4) Station location

(5) File number of application being amended (if known)

 (6) Date of filing of application being amended (if file number is not known)

Applicants should follow the procedures set forth in Parts 0, 1, 73, and 74 of the Commission's rules. 

A copy of the completed application and all related documents shall be made available for inspection by the public in the 

station's online public inspection file pursuant to 47 CFR § 73.3526 for commercial stations and § 73.3527 for 

noncommercial educational (NCE) stations.

Applicants should provide all information requested by this application. No section may be omitted. If any portions of the 

application are not applicable, the applicant should so state. Defective or incomplete applications will be dismissed. 

Inadvertently accepted applications are also subject to dismissal.
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In accordance with 47 CFR § 1.65, applicants have a continuing obligation to advise the Commission, through amendments, 

of any substantial and material changes in the information furnished in this application. This requirement continues until the 

FCC action on this application is no longer subject to reconsideration by the Commission or review by any court.

 

This application requires applicants to certify compliance with many statutory and regulatory requirements. Detailed 

instructions provide additional information regarding Commission rules and policies. These materials are designed to track 

the standards and criteria that the Commission applies to determine compliance and to increase the reliability of applicant 

certifications. They are not intended to be a substitute for familiarity with the Communications Act and the Commission's 

regulations, policies, and precedent. While applicants are required to review all application instructions, they are not 

required to complete or retain any documentation created or collected to complete the application. 

This application is presented primarily in a "Yes/No" certification format. However, it contains appropriate places for 

submitting explanations and attachments where necessary or appropriate. Each certification constitutes a material 

representation. Applicants may only mark the "Yes" certification when they are certain that the response is correct. A "No" 

response is required if the applicant is requesting a waiver of a pertinent rule and/or policy, or where the applicant is 

uncertain that the application fully satisfies the pertinent rule and/or policy. Thus, a "No" response to any of the certification 

items will not cause the immediate dismissal of the application provided that an appropriate exhibit is submitted.

Notification Requirements. All applicants must comply with the requirements of Section 73.1030. Specifically, applicants 

must notify United States Government radio astronomy installations, radio receiving installations, and FCC monitoring 

stations of the proposed facility and its possible impact on their operations. The Commission need not be informed of the 

date of such notification.

GENERAL INFORMATION

Application Description: In the space provided, give a brief (255 characters or fewer) description of the application. 

This is to assist you in identifying this discrete application and will be displayed only in your LMS Application 

workspace. It will not be made a part of your application or be displayed to others.

Uploaded Attachments: Indicate by clicking “Yes” or “No” whether the application includes attachments other than 

required attachments. Required attachments are those that must be filed in response to application questions, and may 

only be required if certain answers are given.

FEES, WAIVERS, AND EXEMPTIONS

Fees: The Commission is statutorily required to collect charges for certain regulatory services to the public. Generally, 

applicants seeking authority to construct a new broadcast station or modify an outstanding authorization are required to 

submit a fee with their application. Government entities, however, are exempt from this fee requirement. Exempt entities 

include possessions, states, cities, counties, towns, villages, municipal organizations, and political organizations or subparts 

thereof governed by elected or appointed officials exercising sovereign direction over communities or governmental 

programs. Also exempt are full-service NCE radio and TV broadcast licensees and permittees, provided that the proposed 

facility will be operated noncommercially. See 47 CFR § 1.1116. 

When filing a fee-exempt application, an applicant must select “Yes” to the question asking if the applicant is exempt from 

FCC application fees. If selecting “Yes,” explain in the text box that opens the reason for the fee exemption. Select “Yes” 

or “No” to the question asking whether the applicant is exempt from payment of FCC annual regulatory fees, as appropriate.

The Application Fee Filing Guide for Media Bureau, obtainable at https://www.fcc.gov/document/media-bureauapplication-fee-filing-guide-1, contains a list of the required fees and Fee Type Codes needed to complete this application. 
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The Commission's fee collection program utilizes a U.S. Treasury lockbox bank for maximum efficiency of collection and 

processing. 

Payment of any required fee must be made by check, bank draft, money order, credit card, or wire transfer. If payment is 

made by check, bank draft, money order, or wire transfer, the remittance must be denominated in U.S. dollars, drawn upon a 

U.S. financial institution, and made payable to the Federal Communications Commission. No postdated, altered, or thirdparty checks will be accepted. DO NOT SEND CASH. Additionally, checks dated six months or older will not be 

accepted.

FCC Form 159, dated February 2003, must be submitted with any application subject to a fee received at the 

Commission. All previous editions of this form are obsolete. Failure to use this version of the form or to submit all 

requested information may delay the processing of the application.

For further information regarding the applicability of a fee, the fee code, the amount of the fee, or the payment of the fee, 

applicants should consult the "Application Fee Filing Guide for Media Bureau," which may be accessed at 

https://www.fcc.gov/document/media-bureau-application-fee-filing-guide-1.

Waivers: If any waiver of the Commission’s rules is requested at any part of the application, select “Yes” to this question. 

If selecting “Yes,” complete the box that opens by stating the number of rule sections for which you request waiver. You 

must then submit an attachment setting forth the waiver(s) sought and the legal justification for waiver.

APPLICANT INFORMATION

Applicant Name and Type. Select the Applicant Type (e.g., Individual, Corporation, Partnership, LLC) from the dropdown menu. In the text box below the drop-down menu, enter the exact legal name of the applicant or applicant entity. 

The name of the applicant must be stated exactly in this item. If the applicant is a corporation, the applicant should list the 

exact corporate name; if a partnership, the name under which the partnership does business; if an unincorporated association, 

the name of an executive officer, his/her office, and the name of the association; and, if an individual applicant, the person's 

full legal name.

Applicant Information: Enter the applicant’s postal address, telephone number, and Email address in the spaces provided. 

Select the applicant’s Country and State from the drop-down menu.

CONTACT REPRESENTATIVES

If the applicant is represented by a third party (such as, for example, legal counsel), that person's name, firm or company, and

telephone/electronic mail address may be specified as Contact Representative. Otherwise, a party to the application or 

another person associated with the applicant may be designated as Contact Representative. This is the person with whom the 

Commission will communicate regarding the application. At least one Contact Representative must be designated. To add a 

Contact Representative, click the “Add Contact” button at the top right of the screen.

Contact Type: Select the button that best describes the contact type, whether Legal Representative (e.g., attorney), 

Technical Representative (e.g., engineer), or Other.

Contact Name: Enter the name of the Contact Representative. If the Contact Representative is the same as the applicant, 

you can pre-fill the Contact Name and Contact Information fields with the applicant information previously provided, by 

clicking the “Pre-fill From Applicant Details” button. If the representative works for a firm or company, enter that name in 

the Company Name space. 

Contact Information: Enter the Contact Representative’s postal address, telephone number, and Email address in the 

spaces provided. Select the Contact Representative’s Country and State from the drop-down menus.
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If you have more than one Contact Representative, click the “Save & Add Another” button at the bottom of the screen and 

complete for the next Contact Representative. When you are finished, click “Save & Continue.” You will be displayed a 

summary screen listing your Contact Representative(s). From this screen you may delete a Contact Representative or edit 

the information provided. If you have no further Contact Representative information to add or edit, click “Save & 

Continue.”

LEGAL CERTIFICATIONS

Programming. An FM translator operator proposing to rebroadcast the signal of a primary station which it does not own 

must obtain written permission of that station prior to retransmission of that signal. See 47 CFR § 74.1284. An FM booster 

operator must rebroadcast the signal of a co-owned primary station. This item requires the applicant to certify either that it is 

the license of the primary station to be rebroadcast or that such authority has been received.

Additionally, the Commission must be notified of the call letters of each station rebroadcast, as well as any changes in 

primary stations. 

For purposes of this item, "rebroadcast" means the reception by radio of the programs or other signals of a radio or television 

station and the simultaneous or subsequent retransmission of such program or signals for direct reception by the general 

public. See Section 74.1284(a).

Station Ready for Operation. This question requires the applicant to certify that the authorized facility is in satisfactory 

operating condition and ready for regular operation. See 47 CFR §§ 73.3598(e), 74.1232(a). Partially constructed facilities, 

or facilities that are less than authorized in the underlying construction permit, are not sufficient.

Character Issues/Adverse Findings. The Character Issues question requires the applicant to certify that neither it nor any 

party to the application has had any interest in or connection with an application that was or is the subject of unresolved 

character issues. An applicant must disclose in response to the Adverse Findings question whether the applicant or any party 

to the application has been the subject of a final adverse finding with respect to certain relevant non-broadcast matters. The 

Commission's character policies and litigation reporting requirements for broadcast applicants focus on misconduct which 

violates the Communications Act or a Commission rule or policy and on certain specified non-FCC misconduct. In 

responding to these questions, applicants should review the Commission's character qualifications policies, which are fully 

set forth in Character Qualifications, 102 FCC 2d 1179 (1985), reconsideration denied, 1 FCC Rcd 421 (1986), as modified, 

5 FCC Rcd 3252 (1990) and 7 FCC Rcd 6564 (1992).

NOTE: As used in this question, the term "party to the application" includes any individual or entity whose ownership or 

positional interest in the applicant is attributable. An attributable interest is an ownership interest in or relation to an

applicant or licensee which will confer on its holder that degree of influence or control over the applicant or licensee 

sufficient to implicate the Commission's multiple ownership rules. See 47 CFR Section 73.3555, as revised and explained in 

Review of the Commission's Regulations Governing Attribution of Broadcast and Cable/MDS Interests, FCC 99-207, 

released August 6, 1999, on reconsideration, FCC 00-438, released January 19, 2001. See also Report and Order in MM 

Docket No. 83-46, 97 FCC 2d 997 (1984), reconsideration granted in part, 58 RR 2d 604 (1985), further modified on 

reconsideration, 61 RR 2d 739 (1986). General guidelines are set forth below.

INVESTORS AND CREDITORS: Certain interests held by substantial investors in, or creditors of, the applicant may also 

be attributable and the investor reportable as a party to the application, if the interest falls within the Commission's 

equity/debt plus (EDP) attribution standard. Under the EDP standard, the interest held is attributable if, aggregating both 

equity and debt, it exceeds 33 percent of the total asset value (all equity plus all debt) of the applicant – a broadcast station 

licensee, cable television system, daily newspaper or other media outlet subject to the Commission’s broadcast multiple 

ownership or cross-ownership rules – AND the interest holder also holds (1) an attributable interest in a media outlet in the 

same market, or (2) supplies over 15 percent of the total weekly broadcast programming hours of the station in which the 
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interest is held. For example, the equity interest of an insulated limited partner in a limited partnership applicant would 

normally not be considered attributable, but, under the EDP standard, that interest would be attributable if the limited 

partner’s interest exceeded 33 percent of the applicant’s total asset value AND the limited partner also held a 5 percent 

voting interest in a radio or television station licensee in the same market.

The interest holder may, however, exceed the 33 percent threshold without triggering attribution where such investment 

would enable an eligible entity to acquire a broadcast station provided that: (1) the combined equity and debt of the interest

holder in the eligible entity is less than 50 percent, or (2) the total debt of the interest holder in the eligible entity does not 

exceed 80 percent of the asset value of the station being acquired by the eligible entity and the interest holder does not hold 

any equity interest, option, or promise to acquire an equity interest in the eligible entity or any related entity. See Promoting 

Diversification of Ownership in the Broadcasting Services, Report and Order and Third Further Notice of Proposed Rule 

Making, 23 FCC Rcd 5922, 5936, para. 31 (2008); 2014 Quadrennial Regulatory Review – Review of the Commission’s 

Broadcast Ownership Rules and Other Rules Adopted Pursuant to Section 202 of the Telecommunications Act of 1996, 

Second Report and Order, 31 FCC Rcd 9864, 9976-84, paras. 271-86 (2016) (2014 Quadrennial Review Order).

INDIVIDUAL APPLICANT: The natural person seeking to hold in his or her own right the authorization specified in this 

application.

PARTNERSHIP APPLICANT: Each partner, including all limited partners. However, a limited partner in a limited 

partnership is not considered a party to the application IF the limited partner is not materially involved, directly or indirectly, 

in the management or operation of the media-related activities of the partnership and the applicant so certifies in response to 

the non-attributable interests question. Sufficient insulation of a limited partner for purposes of this certification would be 

assured if the limited partnership arrangement:

(1) specifies that any exempt limited partner (if not a natural person, its directors, officers, partners, etc.) cannot 

act as an employee of the limited partnership if his or her functions, directly or indirectly, relate to the media enterprises of 

the company;

(2) bars any exempt limited partner from serving, in any material capacity, as an independent contractor or 

agent with respect to the partnership's media enterprises;

(3) restricts any exempted limited partner from communicating with the licensee or the general partner on 

matters pertaining to the day-to-day operations of its business;

(4) empowers the general partner to veto any admissions of additional general partners admitted by vote of the 

exempt limited partners;

(5) prohibits any exempt limited partner from voting on the removal of a general partner or limits this right to 

situations where the general partner is subject to bankruptcy proceedings, as described in Sections 402 (4)-(5) of the Revised 

Uniform Limited Partnership Act, is adjudicated incompetent by a court of competent jurisdiction, or is removed for cause, 

as determined by an independent party;

(6) bars any exempt limited partner from performing any services to the limited partnership materially relating 

to its media activities, with the exception of making loans to, or acting as a surety for, the business; and

(7) states, in express terms, that any exempt limited partner is prohibited from becoming actively involved in 

the management or operation of the media businesses of the partnership.

Notwithstanding conformance of the partnership agreement to these criteria, however, the requisite certification cannot be 

made IF the limited partner’s interest is attributable under the Commission’s EDP attribution standard described above; or IF 

the applicant has actual knowledge of a material involvement of a limited partner in the management or operation of the 
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media-related businesses of the partnership. In the event that the applicant cannot certify as to the noninvolvement of a 

limited partner, the limited partner will be considered as a party to this application.

LIMITED LIABILITY COMPANY APPLICANT: The Commission treats an LLC as a limited partnership, each of whose 

members is considered to be a party to the application. However, where an LLC member is insulated in the manner specified 

above with respect to a limited partnership and where the relevant state statute authorizing the LLC permits an LLC member 

to insulate itself in accordance with the Commission's criteria, that LLC member is not considered a party to the application. 

In such a case, the applicant should certify "Yes" in response to the non-attributable interest question. 

CORPORATE APPLICANT: Each officer, director and owner of stock accounting for 5 percent or more of the issued and 

outstanding voting stock of the applicant is considered a party to the applicant. Where the 5 percent stock owner is itself a 

corporation, each of its stockholders, directors and "executive" officers (president, vice-president, secretary, treasurer or their 

equivalents) is considered a party to this application UNLESS the applicant submits as an exhibit a statement establishing 

that an individual director or officer will not exercise authority or influence in areas that will affect the applicant or the 

station. In this statement, the applicant should identify the individual by name and title, describe the individual's duties and 

responsibilities, and explain the manner in which such individual is insulated from the corporate applicant and should not be 

attributed an interest in the corporate applicant or considered a party to this application. In addition, a person or entity

holding an ownership interest in the corporate stockholder of the applicant is considered a party to this application ONLY IF 

that interest, when multiplied by the corporate stockholder's interest in the applicant, would account for 5 percent or more of 

the issued and outstanding voting stock of the applicant. For example, where Corporation X owns stock accounting for 25 

percent of the applicant's votes, only Corporation X shareholders holding 20 percent or more of the issued and outstanding 

voting stock of Corporation X have a 5 percent or more indirect interest in the applicant (.25 x .20 = .05) and, therefore, are 

considered parties to this application. In applying the multiplier in this context, any entity holding more than 50 percent of 

its subsidiary will be considered a 100 percent owner. Where the 5 percent stock owner is a partnership, each general 

partner and any limited partner that is non-insulated, regardless of the partnership interest, is considered a party to the 

application.

Stock subject to stockholder cooperative voting agreements accounting for 50 percent or more of the votes in a corporate 

applicant will be treated as if held by a single entity and any stockholder holding 5 percent or more of the stock in that block 

is considered a party to this application.

An investment company, insurance company or trust department of a bank is not considered a party to this application, and 

an applicant may properly certify that such entity's interest is non-attributable, IF its aggregated holding accounts for less 

than 20 perecent of the outstanding votes in the applicant AND IF: 

(1) such entity exercises no influence or control over the corporation, directly or indirectly; and

(2) such entity has no representatives among the officers and directors of the corporation.

ANY OTHER APPLICANT: Each executive officer, member of the governing board and owner or holder of 5 percent or 

more of the votes in the applicant is considered a party to the applicant.

Character Issues. Where the response to the Character Issues question is "No," the applicant must submit an attachment 

that includes an identification of the party having had the interest, the call letters and location of the station or file number of 

the application or docket, and a description of the nature of the interest or connection, including relevant dates. The 

applicant should also fully explain why the unresolved character issue is not an impediment to a grant of this application.

Adverse Findings. In responding to the Adverse Findings question, the applicant should consider any relevant adverse 

finding involving the applicant or any party to the application. Where that adverse finding was fully disclosed to the 

Commission in an application filed on behalf of this station or in another broadcast station application and the Commission, 

by specific ruling or by subsequent grant of the application, found the adverse finding not to be disqualifying, it need not be 
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reported again and the applicant may respond "Yes" to this item. However, an adverse finding that has not been reported to 

the Commission and considered in connection with a prior application would require a "No" response.

Where the response to the Adverse Findings question is "No," the applicant must provide in an attachment a full disclosure 

of the persons and matters involved, including an identification of the court or administrative body and the proceeding (by 

dates and file numbers), and the disposition of the litigation. Where the requisite information has been earlier disclosed in 

connection with another pending application, or as required by 47 CFR § 1.65(c), the applicant need only provide an 

identification of that previous submission by reference to the file number in the case of an application, the call letters of the 

station regarding which the application or Section 1.65 information was filed, and the date of filing. The applicant should 

also fully explain why the adverse finding is not an impediment to a grant of this application.

 

CHANNEL AND FACILITY APPLICATION

Proposed Community of License. The Facility ID Number, channel and frequency, and proposed city and state of 

license are pre-filled by LMS, and must match the information on the station’s construction permit.

Facility Type. This item is pre-filled by LMS, and indicates whether the proposal is for a commercial or NCE FM translator 

or booster station.

ANTENNA LOCATION DATA

Coordinates (NAD 83): The proposed antenna site must be specified using North American Datum 83 (NAD 83) 

coordinates. Please indicate North or South Latitude, and East or West Longitude. Note: This is a change from past 

Media Bureau practice, in which latitude and longitude coordinates were specified using North American Datum 27 

(NAD 27). To use prior-specified coordinates, you must convert them from NAD 27 to NAD 83, using the NGS Coordinate 

Conversion and Transformation Tool (NCAT) available here: https://www.ngs.noaa.gov/NCAT/ .

Antenna Data: Effective Radiated Power. The effective radiated power must be entered in kilowatts, and rounded pursuant 

to section 73.212 of the rules.

Transmitter Power Output. The transmitter power output (TPO) must be specified in kilowatts, and rounded pursuant to 

section 73.212. 

ANTENNA TECHNICAL DATA

Antenna Type: The antenna type (Directional or Non-directional) will be pre-filled by LMS based on what was specified in 

the facility’s construction permit.

Primary Station Community of License. Enter the Facility ID number of the primary station to be rebroadcast. LMS will 

then pre-fill the primary station’s community of license (including state), call sign, channel, and service. An error message 

will be generated if the Facility ID number entered does not correspond with a valid primary station.

Delivery Method. The proposed signal delivery method must comply with 47 CFR § 74.1231. All FM translators may 

retransmit the signal of a primary AM or FM radio broadcast station, or a translator which has been received over the air, 

converted to the authorized channel, and suitably amplified.

Certain FM translator stations may use over-the-air reception as well as alternative signal delivery methods, including 

satellite and terrestrial microwave facilities. Select the radio button corresponding to the signal delivery method to be used.
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If the signal is to be received via a translator station, select “Via Call Sign” and then give the call sign of the translator 

station in the box that opens up.

If selecting “Other,” indicate the method of signal delivery in the box that opens up.

Transmitting Antenna. Manufacturer / Make; Model. All applicants must indicate antenna manufacturer and model 

number in the boxes provided. All directional antennas must comply with 47 CFR § 74.1235(i) (which incorporates 47 CFR 

§ 73.316(c)(1) through (c)(3)). 

Number of Sections. The number of sections, in whole numbers from 1 – 20, must be entered in the box provided. 

Spacing Between Sections (wavelength). The spacing between sections in fractions of a wavelength, from 0.5 – 1.5 specified 

to no more than one decimal place, must be entered in the box provided.

Measured Directional Antenna Relative Field Value: If “Directional” is selected under “Antenna Type,” the directional 

antenna must comply with 47 CFR § 74.1235(i). Applicants proposing a directional antenna must complete the table that 

opens at the bottom of the screen for Measured Field Values (VM) (Relative Field Values – VA – are pre-filled by LMS). 

Measured field values (0.001-1.000) must be entered for every 10 degrees on the unit circle from 0 to 350. Up to five 

azimuths may be added at the bottom of the table for additional accuracy. 

TECHNICAL CERTIFICATIONS

Constructed Facility. The applicant must certify that the facility was constructed as authorized in the underlying 

construction permit. If there are any differences between the facilities constructed compared with those authorized in the 

construction permit, the applicant may need to seek approval for the change on Form 2100, Schedule 349. See

47 CFR § 74.1251. 

Special Operating Conditions. The special operating conditions are located on the final pages of the construction permit. 

Supply attachments, if required, to document compliance with the special operating conditions, if any. Please note: 

SPECIAL OPERATING CONDITIONS MAY PROHIBIT AUTOMATIC PROGRAM TEST AUTHORITY. The 

permittee of an FM Translator or Booster station may begin program tests upon filing Schedule 350 with the FCC. See 47 

CFR § 74.14. This provision does not apply if the underlying construction permit contains a special operating 

condition prohibiting automatic program test authority.

Transmitter Power Output. The applicant must certify that the transmitter power output (TPO) produces the authorized 

ERP. The TPO to produce the authorized effective radiated power is calculated as follows:

TPO = Effective Radiated Power / Antenna power gain * Efficiency of Transmission Line System

Remember to change percent values to decimal form before calculating TPO. For example, 86 percent becomes 0.86.

Environmental Effect. This question requires the applicant to state whether grant of a construction permit for the proposed 

facility would be an action that may have a significant environmental effect under 47 CFR § 1.1306. 

The National Environmental Policy Act of 1969 requires all federal agencies to ensure that the human environment is given 

consideration in all agency decision-making. Since January 1, 1986, applications for new broadcast stations, modifications 

of existing stations, and license renewals must contain either an environmental assessment that will serve as the basis for 

further Commission review and action, or an indication that operation of the station will not have a significant environmental 

impact. See 47 CFR § 1.1307(b). In this regard, applicants are required to look at eight environmental factors. These 

factors are relatively self-explanatory, except for the evaluation of whether the station adequately protects the public and 

workers from potentially harmful radiofrequency (RF) electromagnetic fields. In addition, if the applicant proposes a new 
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tower that will exceed 450 feet in height, it must submit an Environmental Assessment as described below. Worksheet # XX

includes both a general environmental evaluation and specific sub-sections for RF exposure analysis. Click the 

“Worksheets” link in the application to access this worksheet. These worksheets are designed to facilitate and substantiate 

the certification called for in Schedule 302. Their use is voluntary, but strongly encouraged.

New RF Exposure Requirements. In 1996, the Commission adopted new guidelines and procedures for evaluating 

environmental effects of RF emissions. All applications subject to environmental processing filed on or after October 15, 

1997, must demonstrate compliance with the new requirements. These new guidelines incorporate two tiers of exposure 

limits:

• General population/uncontrolled exposure limits apply to situations in which the general public may be exposed or 

in which persons who are exposed as a consequence of their employment may not be made fully aware of the 

potential for exposure or cannot exercise control over their exposure. Members of the general public are always 

considered under this category when exposure is not employment-related.

• Occupational/controlled exposure limits apply to human exposure to RF fields when persons are exposed as a 

consequence of their employment and in which those persons who are exposed have been made fully aware of the 

potential for exposure and can exercise control over their exposure. These limits also apply where exposure is of a 

transient nature as a result of incidental passage through a location where exposure levels may be above the general 

populations/uncontrolled limits as long as the exposed person has been made fully aware of the potential for 

exposure and can exercise control over his or her exposure by leaving the area or some other appropriate means.

The new guidelines are explained in more detail in OET Bulletin 65, entitled Evaluating Compliance with FCC Guidelines 

for Human Exposure to Radiofrequency Electromagnetic Fields, Edition 97-01, released August, 1997, and Supplement A: 

Additional Information for Radio and Television Broadcast Stations (referred to here as "OET Bulletin 65" and "Supplement 

A," respectively). Both OET Bulletin 65 and Supplement A can be viewed and/or downloaded from the FCC Internet site at 

https://www.fcc.gov/general/radio-frequency-safety-0#block-menu-block-4 . Additional information may be obtained from 

the RF Safety Group at rfsafety@fcc.gov or (202) 418-2464 or from the FCC Call Center at 1-888-CALL FCC (225-5322).

Worksheets ## XX and XX will enable certain categories of stations to determine whether or the proposed facility will have 

a significant environmental impact as defined by Section 1.1307. All applicants can use the General Environmental 

worksheet. Some, but not all, stations will be able to use the RF worksheet. Generally, the RF worksheet can only be used 

in the following situations: (1) single use tower; (2) single tower with several FM/FM translators; or (3) a multiple tower 

AM array with no other user co-located within the array. Additionally, in order to be eligible to use the RF worksheet, 

access to AM stations must be restricted by a fence or other barrier that will preclude casual or inadvertent access to the site 

and warning signs must be posted at appropriate intervals describing the potential for RF exposure. Click the “Worksheets” 

link in the application for more detail on eligibility.

If after using the worksheets the applicant finds that levels will exceed the RF guidelines, levels may still be acceptable 

based on a more detailed evaluation of a number of variables (e.g., antenna radiation patterns or measurement data). In that

case, the applicant must submit an attachment to the application that explains why the proposed facility does not exceed the 

RF radiation exposure guidelines at locations where humans are likely to be present, or describing measures or 

circumstances which will prevent or discourage humans from entering those areas where the RF exposure exceeds the 

guidelines (e.g., fencing or remote location). The guidelines are explained in more detail in OET Bulletin 65. 

If the applicant is not eligible to use the worksheets, it is not an indication that the proposed facility will cause excessive 

exposure. Generally, applicants that are not able to use the worksheets will need to utilize more complex calculations or 

measurements to demonstrate compliance. For this reason, applicants who are not eligible to use the Commission’s Web 

worksheets should consider seeking the assistance of a qualified consulting engineer in determining whether the proposed 

facility will meet the RF exposure guidelines.
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Should the applicant be unable to conclude that its proposal will have no significant impact on the quality of the human 

environment, or if it proposes a new tower exceeding 450 feet in height, it must submit an Environmental Assessment 

containing the following information:

1. A description of the facilities as well as supporting structures and appurtenances, and a description of the site as well 

as the surrounding area and uses. If high-intensity white lighting is proposed or utilized within a residential area, the 

EA must also address the impact of this lighting upon the residents.

2. A statement as to the zoning classification of the site, and communications with, or proceedings before and 

determinations (if any) by zoning, planning, environmental and other local, state, or federal authorities on matters 

relating to environmental effects.

3. A statement as to whether construction of the facilities has been a source of controversy on environmental grounds 

in the local community.

4. A discussion of environmental and other considerations that led to the selection of the particular site and, if relevant, 

the particular facility; the nature and extent of any unavoidable adverse environmental effects; and any alternative 

sites or facilities that have been or reasonably might be considered.

5. If relevant, a statement why the site cannot meet the FCC guidelines for RF exposure with respect to the public and 

workers.

NOTE: Even if the applicant concludes that human RF electromagnetic exposure is consistent with the Commission's 

guidelines, each site user must also meet requirements with respect to "on-tower" or other exposure by workers at the site 

(including RF exposure on one tower caused by sources on another tower or towers). These requirements include, but are 

not limited to, the reduction or cessation of transmitter power when persons have access to the site, tower, or antenna. Such 

procedures must be coordinated among all tower users. See OET Bulletin 65 for details. See also 47 CFR § 1.1306.

CERTIFICATION

General Certification Statements: Each applicant waives any claim to the use of any particular frequency or of the 

electromagnetic spectrum as against the regulatory power of the United States because of the previous use of such 

frequency(ies) or spectrum, whether by authorization or otherwise.

Each applicant is responsible for the information that the application instructions convey. As a key element in the 

Commission's streamlined licensing process, a certification is required that these materials have been reviewed and that each 

question response is based on the applicant's review.

This question also requires the applicant to certify that neither it nor any party to the application is subject to denial of 

federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. § 862. 

Section 5301 of the Anti-Drug Abuse Act of 1988 provides federal and state court judges the discretion to deny federal 

benefits to individuals convicted of offenses consisting of the distribution or possession of controlled substances. Federal

benefits within the scope of the statute include FCC authorizations. The applicant, by electronically signing the application, 

certifies that neither it nor any party to this application has been convicted of such an offense or, if it has, it is not ineligible 

to receive the authorization sought by this application because of Section 5301.

NOTE: With respect to this certification, the term "party to the application" includes, if the applicant is an individual, that 

individual; if the applicant is a corporation or unincorporated association, all officers, directors, or persons holding five

percent or more of the outstanding stock or shares (voting and/or non-voting) of the applicant; all members if a membership 
All previous editions obsolete. Form 2100, Schedule 350 Instructions

 May 2019

11

association; and if the applicant is a partnership, all general partners and all limited partners, including both insulated and 

non-insulated limited partners, holding a five percent or more interest in the partnership. See 47 CFR § 1.2002(b)-(c).

Authorized Party to Sign: The applicant must electronically sign the application. Depending on the nature of the 

applicant, the application should be signed as follows: if a sole proprietorship, personally; if a partnership, by a general 

partner; if a corporation, by an officer; for an unincorporated association, by a member who is an officer; if a governmental

entity, by such duly elected or appointed official as is competent under the laws of the particular jurisdiction. Counsel may 

sign the application for his or her client, but only in cases of the applicant's disability or absence from the United States. In 

such cases, counsel must separately set forth why the application is not signed by the client. In addition, as to any matter 

stated on the basis of belief instead of personal knowledge, counsel shall separately set forth the reasons for believing that 

such statements are true. See 47 CFR § 73.3513. The electronic signature will consist of the electronic equivalent of the 

typed name of the individual. See Report and Order in MM Docket No. 98-43, 13 FCC Rcd 23056, 23,064 (1998), ¶ 17.

Applicant must also check the box to certify that it has submitted with the application all required and relevant attachments.

Click the “Submit Application” button to submit the application. The application is not considered to be submitted 

unless and until you click the “Submit Application” button.

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT

We have estimated that each response to this collection of information will take 1 hour depending on the type of application 

filed. Our estimate includes the time to read the instructions, look through existing records, gather and maintain the required 

data, and actually complete and review the form or response. If you have any comments on this burden estimate, or on how 

we can improve the collection and reduce the burden it causes you, please Email them to pra@fcc.gov or send them to the 

Federal Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-0404), Washington, DC 20554. 

Please DO NOT SEND COMPLETED APPLICATIONS TO THIS ADDRESS. Remember - 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 of if we fail to provide you with this notice. 

This collection has been assigned an OMB control number of 3060-0404.

THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, 

OCTOBER 1, 1995, 44 U.S.C. 3507.