UNITED STATES of AMERICA FEDERAL COMMUNICATIONS COMMISSION 1270 FAIRFIELD ROAD GETTYSBURG, PENNSYLVANIA 17325-7245 TELEPHONE (717) 337-1212 INSTRUCTIONS FOR APPLICATION FORM 610 FOR AMATEUR OPERATOR/PRIMARY STATION LICENSE (Do Not Return Instructions With Application Form) GENERAL INSTRUCTIONS * Use the attached FCC Form 610 to request: 1. An examination for a new amateur operator/primary station license or for modification of your license to a higher operator class. 2 A modification of your name or mailing address as it appears on your license, or a systematic assignment of a different call sign. 3. A renewal of your license if it is unexpired or if it expired within the two year grace period. * Do NOT use the attached FCC Form 610 to request: 1. A Reciprocal Permit for Alien Amateur Licensee. Use FCC Form 610 A. 2. A renewal or modification of a club, military recreation, or RACES station license. Use FCC Form 610 B. * ANTENNA HEIGHT: If the height of your antenna will exceed 61 meters (200 feet) or 1/100 of the minimum distance between the antenna site and any aircraft landing area (refer to Section 97.15) complete FCC Form 854 (Request for Antenna Height Clearance and Obstruction Marking and Lighting Specifications). Forms may be obtained from the Commission's Form Distribution Center, phone (202) 632-FORM. * If you have not received a response from us within 90 days, write to Federal Communications Commission, 1270 Fairfield Road, Gettysburg, PA 17325-7245. Include a photocopy of your completed FCC Form 610, or the following information: 1. Your name, address, and date of birth; 2. Your station call sign and operator class; 3. The date that you filed FCC Form 610; 4. The purpose of the FCC Form 610 you filed; 5. The name of the coordinating VEC; 6. The location of the test site (city and state) and the date of the examination. * Every amateur operator should have a current copy of the amateur service rules, Part 97, which may be obtained from private publishers, vendors, or you may order 47 CFR, Part 80 to End from the U. S. Government Printing Office, Washington, DC 20402, phone (202) 783-3238. * Detach your completed FCC Form 610 from these instructions. Make a photocopy of it for your records. File your completed FCC Form 610 with the VEs if you have marked Box 4A or 4B on the application. If you have marked box(es) 4C through 4F, mail FCC Form 610 WITHOUT A FEE to: FEDERAL COMMUNICATIONS COMMISSION 1270 FAIRFIELD RD GETTYSBURG PA 17325-7245 INSTRUCTIONS TO EXAMINEE A. Your examination will be administered at a location and time specified by your administering VEs. You must comply with their instructions. The VEs will observe you throughout the examination. They are responsible for the proper conduct and necessary supervision of the examination. They must immediately terminate the examination if you fail to comply with their instructions. B. If you hold an unexpired license, or if you hold a license that expired less than two years before the date of the examination session, attach a photocopy of it, or the original, to the application. C. Give your completed FCC Form 610 to your administering VEs. Show your VEs at least two documents that prove your identity. Show your VEs any of the following documents for which you are claiming element credit: 1. Original document of your unexpired (or expired within the grace period) amateur operator/primary station license; 2. Certificate(s) of Successful Completion of Examination, if issued to you within 365 days of this examination session; 3. Photocopy of FCC Form 610 that was filed indicating that you qualified for a Novice Class operator license within 365 days of this examination session; 4. Original document of your unexpired (or expired less than five years prior to this examination session) FCC Commercial Radiotelegraph Operator's Certificate. INSTRUCTIONS TO PERSONS WITH SEVERE HANDICAPS A. If you have passed the 5 words per minute telegraphy examination, but you are unable to pass the 13 or 20 words per minute examination because of a severe handicap that will extend for more than 365 days, the administering VEs will give you credit for passing the 20 words per minute examination if you obtain a Physician's Certification of Disability. You should, however, first attempt to pass the examination under the special accommodative procedures the VEs use for handicapped examinees. B. Detailed Instructions: 1. Complete Items 1 through 9 on FCC Form 610. 2. Present your physician with your completed FCC Form 610 and the Notice to Physician Certifying to a Disability. 3. Provide the physician with the names and addresses of your administering VEs and other amateur operators in your community who can provide more information on this matter. 4. Ask your physician to complete and sign the Physician s Certification of Disability in Section 3 of FCC Form 610. 5. Sign and date the Patient's Release in Section 3 of FCC Form 610. 6. Follow Instructions to Examinee. FCC Form 610-instructions November 1993 INSTRUCTIONS FOR COMPLETING APPLICATION FORM 610 ITEM 1 - Print (or type) your last name and any suffix (Jr., Sr., II, etc.), first name, and middle initial. The name you enter in item 1 must agree with your signature in Item 8. It must also agree with the name on your existing license unless you request a change in Box 4C. ITEM 2 - Print numbers for the month, day, and year of your birth. Example: If you were born on September 20, 1944, enter 09-20-44. ITEM 3 - Print your mailing address. It must be an address where you can receive mail delivered by the United States Postal Service. (Mail delivery may not be available in certain territories.) Print your two-letter state/territory code from the table. For Midway Island, print its full name in the city box. Alabama AL Alaska AK Arizona AZ Arkansas AR California CA Colorado CO Connecticut CT Delaware DE District of Columbia DC Florida FL Georgia GA Hawaii HI Idaho ID Illinois IL Indiana IN Iowa IA Kansas KS Kentucky KY Louisiana LA Maine ME Maryland MD Massachusetts MA Michigan MI Minnesota MN Mississippi MS Missouri MO Montana MT Nebraska NE Nevada NV New Hampshire NH New Jersey NJ New Mexico NM New York NY North Carolina NC North Dakota ND Ohio OH Oklahoma OK Oregon OR Pennsylvania PA Rhode Island RI South Carolina SC South Dakota SD Tennessee TN Texas TX Utah UT Vermont VT Virginia VA Washington WA West Virginia WV Wisconsin WI Wyoming WY American Samoa AS Guam GU Midway Island UM Northern Mariana Is MP Puerto Rico PR Virgin Islands VI ITEM 4 - Place an "X" in the proper box to apply for: BOX 4A An EXAMINATION for a new amateur operator/primary station license. See Instructions to Examinee on reverse. You are eligible for an examination for a new license if you do not have one or if your license has expired beyond the two year grace period. BOX 4B An EXAMINATION to upgrade your license to a higher class. See Instructions to Examinee on reverse. BOX 4C CHANGE your name as it appears on your license to your new name in Item 1. Print your former name where indicated. BOX 4D CHANGE your mailing address as it appears on your license to your new address in Item 3. BOX 4E CHANGE your station call sign. See Fact Sheet PR-5000, Number 206, Amateur Station Call Sign Assignment System, latest date of issue, for information on how the call sign will be systematically assigned. After the call sign change is made, your previous call sign cannot be reinstated. Initial in the space provided. BOX 4F RENEWAL of your unexpired license or RENEWAL of your license if it expired within the grace period. The expiration date must be within the two year grace period. Application must be received by the Commission's Gettysburg office prior to the end of the grace period. ITEM 5 - If your license document was lost or destroyed, attach to your FCC Form 610 a sheet of paper containing your explanation. ITEM 5A - Print the call sign shown on your license. ITEM 5B - Print the operator class shown on your license. ITEM 6 - If the construction of your station would be an action that is likely to have a significant environmental effect, mark "Yes" and attach to your FCC Form 610 an environmental assessment. Otherwise, mark "No". See the Commission's Rules, 47 C.F.R., Part l, Subpart I, and Section 97.13 (a). ITEM 7 - If you have filed another Form 610 that we have not acted upon, give the purpose of the other form in Box 7A and print the month, day, and year it was filed in Box 7B. ITEM 8 - Sign your name. Your signature must agree with your name as printed in Item 1. ITEM 9 - Print the month, day, and year that you sign your application. Public reporting burden for this collection of information is estimated to average ten minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden to the Federal Communications Commission, Records Management Division, AMD-PIRS, Washington, DC 20554, and to the Office of Management and Budget, Paperwork Reduction Project (3060-0003) Washington, DC 20503. NOTICE TO INDIVIDUALS REQUIRED BY THE PRIVACY ACT OF 1974 AND THE PAPERWORK REDUCTION ACT OF 1980 The solicitation of personal information requested in this form is authorized by the Communications Act of 1934, as amended. The Commission will use the information provided in this form) to determine whether grant of this application is in the public interest. In reaching that decision, or for law enforcement purposes, it may become necessary to refer personal information contained in this form to another government agency. In addition, all information provided in this form. as well as the form itself, will be available for public inspection. If information requested on the form is not provided, processing of the application may be delayed or the application may be returned without action pursuant to Commission rules. The foregoing notice is required by the Privacy Act of 1974, 5 U.S.C. Section 522a(e)(3). FCC Form 610 Instructions November 1993