If you need assistance with this form, please call 410-266-6030. Ground Station Interference Form Submitter's Information Name * Name First First Last Last Phone * Email * Administrative Information Licensee Name * Contact Name Contact Name First First Last Last Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone * Email * Description & Location of System Affected FCC Call Sign * Frequency * Transmitter Address * Transmitter Address Transmitter Address Transmitter Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Coordinates Physical location of radio * (Bldg #, Room #, etc) Physical Location of Antenna * (e.g., On roof above gate C10) Interference Description Approximate Description of Interference * (Constant, Intermittent, Sporadic, etc) Type of Interference Being Received * (Voice, Data Bursts, Squeals, etc) How long has the interference been going on? * Remarks If you are human, leave this field blank. Submit
