Claim Technical information to be provided Technical information to be provided License approval number - Select - Type of scrambled transmission Type of scrambled transmission - Select -PMRAmateurHertzian beamsOther… Enter other… Frequency band / Frequency Direction of transmission Up Down Polarization Horizontal Vertical Description of the Blurred Site Description of the Blurred Site Name Code Address Address City Governorate - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal code Country Geographical coordinates (WGS 84) Geographical coordinates (WGS 84) Latitude Degree Minute Second Direction Longitude Degree Minute Second Direction contact Contact Contact person Mobile phone number Mobile phone number Interference information Permanent interference Yes No Days noted Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time range from Time range from : Time a a: Time Daily interference reports One file only.8 MB limit.Allowed types: pdf, png, jpg, tif. Equipment concerned Nature of the disturbance Carrier Broadband Disturbance equipment user identification Other information
