Statement of Account for Secondary Transmissions by Cable Systems (Short Form) (United States)
This is a short form statement of account for licensing secondary cable systems. The form provided here is simply a sample of what the actual Form SA 1-2 looks like.
THIS FORM IS EFFECTIVE FOR ACCOUNTING PERIODS BEGINNING JANUARY 1, 1998.
If you are filing for a prior accounting period, contact the Licensing Division for the correct form.
SA1-2
Short Form
Return to:
LIBRARY OF CONGRESS
COPYRIGHT OFFICE
LICENSING DIVISION
101 INDEPENDENCE AVE., S.E.
WASHINGTON, DC 20557-6400
(202) 707-8150
THIS FORM IS EFFECTIVE FOR ACCOUNTING PERIODS BEGINNING JANUARY 1, 1990.
If you are filing for a prior accounting period, contact the Licensing Division for the correct form.
FOR COPYRIGHT OFFICE USE ONLY
DATE RECEIVED _______________________
AMOUNT $_______________________
ALLOCATION NUMBER _______________________
STATEMENT OF ACCOUNT
for Secondary Transmissions by Cable Systems (Short Form)
A Accounting Period
ACCOUNTING PERIOD COVERED BY THIS STATEMENT: (Check on of the boxes and fill in the year date.)
____ January 1 - June 30, ___________ (Year)
____ July 1 - December 31, __________ (Year)
B Owner
INSTRUCTIONS:
Give the full legal name of the owner of the cable system in Line 1. If the owner is a subsidiary of another corporation, give the full corporate title of the subsidiary, not that of the parent corporation.
In Line 2, list any other names under which the owner conducts the business of the cable system.
____ Check here if this is the system's first filing. If not, enter the system's ID number assigned by the Licensing Division. __________
1 LEGAL NAME OF OWNER OF CABLE SYSTEM _______________________
2 BUSINESS NAME(S) OF OWNER OF CABLE SYSTEM (IF DIFFERENT):
_______________________
3 MAILING ADDRESS OF OWNER OF CABLE SYSTEM:
_______________________ (Number, Street, Rural Route, Apartment or Suite Number)
_______________________ (City, Town, State, ZIP Code)
C System
INSTRUCTIONS: In line 1, give any business or trade names used to identify the business and operation of the system unless these names already appear in space B. In line 2, give the mailing address of the system, if different from the address given in space B.
1 IDENTIFICATION OF CABLE SYSTEM: _______________________
2 MAILING ADDRESS OF CABLE SYSTEM:
_______________________ (Number, Street, Rural Route, Apartment or Suite Number)
_______________________ (City, Town, State, ZIP Code)
D Area Served
INSTRUCTIONS: List each separate community served by the cable system. A "community" is the same as a "community unit" as defined in FCC rules: ". . . a separate and distinct community or municipal entity (including unincorporated communities within unincorporated areas and including single, discrete unincorporated areas.") 47 C.F.R. §76.5(mm). The first community that you list will serve as a form of system identification hereafter known as the "First Community." Please use it as the First Community on all future filings.
Note: Entities and properties such as hotels, apartments, condominiums or mobile home parks should be reported in parentheses below the identified city.
First Community
CITY OR TOWN _______________________
STATE _______________________
CITY OR TOWN _______________________
STATE _______________________
LEGAL NAME OF OWNER OF CABLE SYSTEM: _______________________
E Secondary transmission Service: Subscribers and Rates
SECONDARY TRANSMISSION SERVICE: SUBSCRIBERS AND RATES
In General: The information in space E should cover all categories of "secondary transmission service" of the cable system: that is, the retransmission of television and radio broadcasts by your system to subscribers. Give information about other services (including pay cable) in space F, not here. All the facts you state must be those existing on the last day of the accounting period (June 30 or December 31, as the case may be).
Number of Subscribers: Both blocks in space E call for the number of subscribers to the cable system, broken down by categories of secondary transmission service. In general, you can compute the number of "subscribers" in each category by counting the number of billings in that category (the number of persons or organizations charged separately for the particular service at the rate indicated--not the number of sets receiving service).
Rate: Give the standard rate charged for each category of service. Include both the amount of the charge and the unit in which it is generally billed. (Example: "$8/mth"). Summarize any standard rate variations within a particular rate category, but do not include discounts allowed for advance payment.
Block 1:In the left-hand block in space E, the form lists the categories of secondary transmission service that cable systems most commonly provide to their subscribers. Give the number of subscribers and rate for each listed category that applies to your system. Note: Where an individual or organization is receiving service that falls under different categories, that person or entity should be counted as a "subscriber" in each applicable category. Example: a residential subscriber who pays extra for cable service to additional sets would be included in the count under "Service to the First Set," and would be counted once again under "Service to Additional Set(s)."
Block 2: If your cable system has rate categories for secondary transmission service that are different from those printed in block 1, (for example, tiers of services which include one or more secondary transmissions), list them, together with the number of subscribers and rates, in the right-hand block. A two or three word description of the service is sufficient.
BLOCK 1
CATEGORY OF SERVICE
Residential:
• Service to First Set
NO. OF SUBSCRIBERS _______________________
RATE _______________________
• Service to Additional Set(s)
NO. OF SUBSCRIBERS _______________________
RATE _______________________
• FM Radio (if separate rate)
NO. OF SUBSCRIBERS _______________________
RATE _______________________
Motel, Hotel
NO. OF SUBSCRIBERS _______________________
RATE _______________________
Commercial
NO. OF SUBSCRIBERS _______________________
RATE _______________________
Converter
• Residential
NO. OF SUBSCRIBERS _______________________
RATE _______________________
• Non-Residential
NO. OF SUBSCRIBERS _______________________
RATE _______________________
BLOCK 2
CATEGORY OF SERVICE
Residential:
• Service to First Set
NO. OF SUBSCRIBERS _______________________
RATE _______________________
• Service to Additional Set(s)
NO. OF SUBSCRIBERS _______________________
RATE _______________________
• FM Radio (if separate rate)
NO. OF SUBSCRIBERS _______________________
RATE _______________________
Motel, Hotel
NO. OF SUBSCRIBERS _______________________
RATE _______________________
Commercial
NO. OF SUBSCRIBERS _______________________
RATE _______________________
Converter
• Residential
NO. OF SUBSCRIBERS _______________________
RATE _______________________
• Non-Residential
NO. OF SUBSCRIBERS _______________________
RATE _______________________
SERVICES OTHER THAN SECONDARY TRANSMISSIONS: RATES
In General: Space F calls for rate (not subscriber) information with respect to all your cable system's services that were not covered in space E. That is, those services that are not offered in combination with any secondary transmission service for a single fee. There are two exceptions: you do not need to give rate information concerning: (1) services furnished at cost; and (2) services or facilities furnished to nonsubscribers. Rate information should include both the amount of the charge and the unit in which it is usually billed. If any rates are charged on a variable per-program basis, enter only the letters "PP" in the rate column.
Block 1: Give the standard rate charged by the cable system for each of the applicable services listed.
Block 2: List any services that your cable system furnished or offered during the accounting period that were not listed in block 1 and for which a separate charge was made or established. List these other services in the form of a brief (two or three word) description, and include the rate for each.
F Services Other Than Secondary Transmissions: Rates
Continuing Services:
CATEGORY OF SERVICE
BLOCK 1
• Pay Cable
RATE _______________________
• Pay Cable--Add'l Channel
RATE _______________________
• Fire Protection
RATE _______________________
•Burglar Protection
RATE _______________________
Installation: Residential
• First Set
RATE _______________________
• Additional Set(s)
RATE _______________________
• FM Radio (if separate rate)
RATE _______________________
• Converter
RATE _______________________
Installation: Non-Residential
• Motel, Hotel
RATE _______________________
• Commercial
RATE _______________________
• Pay Cable
RATE _______________________
• Pay Cable--Add'l Channel
RATE _______________________
• Fire Protection
RATE _______________________
• Burglar Protection
RATE _______________________
Other Services:
• Reconnect
RATE _______________________
• Disconnect
RATE _______________________
• Outlet Relocation
RATE _______________________
• Move to New Address
RATE _______________________
BLOCK 2
CATEGORY OF SERVICE
Installation: Non-Residential
• _______________________
RATE _______________________
• _______________________
RATE _______________________
• _______________________
RATE _______________________
• _______________________
RATE _______________________
G Primary Transmitters: Television
INSTRUCTIONS:
General: In space G, identify every television station (including translator stations and low power television stations) carried by your cable system during the accounting period, except: (1) stations carried only on a part-time basis under FCC rules and regulations in effect on June 24, 1981 permitting the carriage of certain network programs [sections 76.59(d)(2) and (4), 76.61(e)(2) and (4) or 76.63 (referring to 76.61(e)(2) and (4))]; and (2) certain stations carried on a substitute program basis, as explained in the next paragraph.
Substitute Basis Stations: With respect to any distant stations carried by your cable system on a substitute program basis under specific FCC rules, regulations, or authorizations:
• Do not list the station here in space G--but do list it in space I (the Special Statement Program Log)--if the station was carried only on a substitute basis.
• List the station here, and also in space I, if the station was carried both on a substitute basis and also on some other basis. For further information concerning substitute basis stations, see page (v) of the General Instructions.
Column 1: List each station's call sign. Do not report program services such as HBO, ESPN, etc.
Column 2: Give the number of the channel on which the station's broadcasts are carried in its own community. This may be different from the channel on which your cable system carried the station.
Column 3: Indicate in each case whether the station is a network station, an independent station, or a noncommercial educational station, by entering the letter "N" (for network), "I" (for independent) or "E" (for noncommercial educational). For the meaning of these terms, see page (iv) of the General Instructions.
Column 4: If the station is "distant" enter "Yes." If not, enter "No." For explanation of what a "distant station" is, see page (iv) of the General Instructions.
Column 5: If you have entered "Yes" in column 4, you must complete column 5, stating the basis on which your cable system carried the distant station during the accounting period. Indicate by entering "LAC" if your cable system carried the distant station on a part-time basis because of lack of activated channel capacity. If you carried the channel on any other basis, enter "O". For a further explanation of these two categories, see page (iv) of the General Instructions.
Column 6: Give the location of each station. For U.S. stations, list the community to which the station is licensed by the FCC. For Mexican or Canadian stations, if any, give the name of the community with which the station is identified.
1. CALL SIGN
_______________________
_______________________
2. B'CAST CHANNEL NUMBER
_______________________
_______________________
3. TYPE OF STATION
_______________________
_______________________
4. LOCATION OF STATION
_______________________
_______________________
H Primary Transmitters: Radio
PRIMARY TRANSMITTERS: RADIO
In General: List every radio station carried on a separate and discrete basis and list those FM stations carried on an all-band basis whose signals were "generally receivable" by your cable system during the accounting period.
Special Instructions Concerning All-Band FM Carriage: Under Copyright Office Regulations, an FM Signal is "generally receivable" if: (1) "it is carried by the system whenever it is received at the system's headend"; and (2) it can be expected, on the basis of monitoring, to be received at the headend, with the system's FM antenna, during certain stated intervals. For detailed information about the Copyright Office Regulations on this point, see page (v) of the General Instructions.
Column 1: Identify the call sign of each station carried.
Column 2: State whether the station is AM or FM.
Column 3: If the radio station's signal was electronically processed by the cable system as a separate and discrete signal, indicate this by placing a check mark in the "S/D" column.
Column 4: Give the station's location (the community to which the station is licensed by the FCC or, in the case of Mexican or Canadian stations, if any, the community with which the station is identified).
CALL SIGN
_______________________
_______________________
AM or FM
_______________________
_______________________
S/D
_______________________
_______________________
LOCATION OF STATION
_______________________
_______________________
I Substitute Carriage: Special Statement and Program Log
GENERAL:
In space I, identify every non-network television program, broadcast by a distant station, that your cable system carried on a substitute basis during the accounting period, under specific present and former FCC rules, regulations, or authorizations. For a further explanation of the programming that must be included in this log, see page (v) of the General Instructions.
1. SPECIAL STATEMENT CONCERNING SUBSTITUTE CARRIAGE:
• During the accounting period, did your cable system carry, on a substitute basis, any non-network television program broadcast by a distant station? ____ Yes ____ No
Note: If your answer is "No", leave the rest of this page blank. If your answer is "Yes", you must complete the program log in block 2.
2. LOG OF SUBSTITUTE PROGRAMS:
In General: List each substitute program on a separate line. Use abbreviations wherever possible, if their meaning is clear. If you need more space, please attach additional pages.
Column 1: Give the title of every non-network television program ("substitute program") that, during the accounting period, was broadcast by a distant station and that your cable system substituted for the programming of another station under certain FCC rules, regulations, or authorizations. See page (v) of the General Instructions for further information. Do not use general categories like "movies" or "basketball." List specific program titles, for example, "I Love Lucy" or "NBA Basketball: 76ers vs. Bulls".
Column 2: If the program was broadcast live, enter "Yes". Otherwise enter "No".
Column 3: Give the call sign of the station broadcasting the substitute program.
Column 4: Give the broadcast station's location (the community to which the station is licensed by the FCC or, in the case of Mexican or Canadian stations, if any, the community with which the station is identified).
Column 5: Give the month and day when your system carried the substitute program. Use numerals, with the month first. Example: for May 7 give "5/7".
Column 6: State the times when the substitute program was carried by your cable system. List the times accurately to the nearest five minutes. Example: a program carried by a system from 6:01:15 p.m. to 6:28:30 p.m. should be stated as "6:00--6:30 p.m."
Column 7: Enter the letter "R" if the listed program was substituted for programming that your system was required to delete under FCC rules and regulations in effect during the accounting period; or enter the letter "P" if the listed program was substituted for programming that your system was permitted to delete under FCC rules and regulations in effect on October 19, 1976.
SUBSTITUTE PROGRAM
1. TITLE OF PROGRAM
_______________________
_______________________
2. LIVE? Yes or No
_______________________
_______________________
3. STATION'S CALL SIGN
_______________________
_______________________
4. STATION'S LOCATION
_______________________
_______________________
WHEN SUBSTITUTE CARRIAGE OCCURRED
5. MONTH AND DAY
_______________________
_______________________
6. TIMES FROM -- TO
_______________________
_______________________
7. REASON FOR DELETION
_______________________
_______________________
K Gross Receipts
GROSS RECEIPTS
Instructions: The figure you give in this space determines the form you file and the amount you pay. Enter the total of all amounts ("gross receipts") paid to your cable system by subscribers for the system's "secondary transmission service" (as identified in space E) during the accounting period. For a further explanation of how to compute this amount, see page (v) of the General Instructions.
• Gross receipts from subscribers for secondary transmission service(s) during the accounting period.
IMPORTANT: You must complete a statement in space P concerning gross receipts. $_______________________ (Amount of "gross receipts")
L Copyright Royalty Fee Block
INSTRUCTIONS FOR COMPUTING THE COPYRIGHT ROYALTY FEE
To compute the royalty fee you owe:
• Complete either block 1, block 2 or block 3
• Use block 1 if the amount of "gross receipts" in space K is $75,800 or less
• Use block 2 if the amount of "gross receipts" in space K is more than $75,800 but less than or equal to $146,000
• Use block 3 if the amount of "gross receipts" in space K is more than $146,000 but less than $292,000
See page (vi) of the General Instructions for more Information.
Block 1: GROSS RECEIPTS" OF $75,800 OR LESS
INSTRUCTIONS: As a cable system with "gross receipts" of $75,800 or less, the royalty fee that you must pay for this six-month accounting period is $28.00
Line 2. Interest Charge. Enter the amount from line 4, space Q, page 8
Line 3. TOTAL ROYALTY FEE PAYABLE FOR ACCOUNTING PERIOD. Add lines 1 and 2
Block 2: GROSS RECEIPTS" OF $146,000 OR LESS (but more than $75,800)
1. Base amount under statutory formula $146,000
2. Enter amount of "gross receipts" from space K _______________________
3. Subtract line 2 from line 1 _______________________
4. Enter the amount of "gross receipts" from space K _______________________
5. Enter the amount from line 3 _______________________
6. Subtract line 5 from line 4 _______________________
7. Multiply line 6 by .005 (enter figure here) $_______________________
8. Interest Charge. Enter the amount from line 4, space Q, page 8 $_______________________
9. TOTAL ROYALTY FEE PAYABLE FOR ACCOUNTING PERIOD. Add lines 7 and 8 $_______________________
BLOCK 3: "GROSS RECEIPTS" OF MORE THAN $146,000 (but less than $292,000)
1. Enter the amount of "gross receipts" from space K $_______________________
2. Base amount under statutory formula $146,000
3. Subtract line 2 from line 1 _______________________
4. Multiply line 3 by .01 _______________________
5. Royalty due on the first $146,000 of gross receipts (under statutory formula) $730
6. Interest Charge. Enter the amount from line 4, space Q, page 8 $_______________________
7. TOTAL ROYALTY FEE PAYABLE FOR ACCOUNTING PERIOD. Add lines 4, 5, and 6 $_______________________
IMPORTANT: When you file your Statement of Account on this form, SA1-2, you must also enclose with it the royalty fee you have computed in block 1, block 2, or block 3, above. Your remittance must be in the form of an electronic payment, certified check, cashier's check, or money order, payable to: Register of Copyrights. Other forms of remittance, including personal or company checks will be returned. Do not send cash. We recommend electronic payments.
N Channels
CHANNELS
INSTRUCTIONS: You must give: (1) the number of channels on which the cable system carried television broadcast stations to its subscribers; and, (2) the cable system's total number of activated channels, during the accounting period.
1. Enter the total number of channels on which the cable system carried television broadcast stations.
2. Enter the total number of activated channels on which the cable system carried television broadcast stations and nonbroadcast services.
N Contact
INDIVIDUAL TO BE CONTACTED IF FURTHER INFORMATION IS NEEDED: (Identify an individual to whom we can write or call about this Statement of Account.)
Name _______________________
Telephone _______________________ (Area Code)
Address _______________________ (Number, Street, Rural Route, Apartment or Suite Number)
_______________________ (City, Town, State, ZIP Code)
O Certification
CERTIFICATION: (This Statement of Account must be certified and signed in accordance with Copyright Office Regulations, as explained in the General Instructions.)
• I, the undersigned, hereby certify that: (Check one, but only one, of the boxes.)
____ (Owner other than corporation or partnership) I am the owner of the cable system as identified in line 1 of space B; or
____ (Agent of owner other than corporation or partnership) I am the duly authorized agent of the owner of the cable system as identified in line 1 of space B, and that the owner is not a corporation or partnership; or
____ (Officer or partner) I am an officer (if a corporation) or a partner (if a partnership) of the legal entity identified as owner of the cable system in line 1 of space B.
• I have examined the Statement of Account and hereby declare under penalty of law that all statements of fact contained herein are true, complete, and correct to the best of my knowledge, information, and belief, and are made in good faith. [18 U.S.C., Section 1001(1986)]
Handwritten signature: (X) _______________________
Typed or printed name: _______________________
Title: _______________________ (Title of official position held in corporation or partnership)
Date: _______________________
P Statement of Gross Receipts
SPECIAL STATEMENT CONCERNING GROSS RECEIPTS EXCLUSION
The Satellite Home Viewer Act of 1988 amended Title 17, section 111(d)(1)(A), of the Copyright Act by adding the following sentence:
"In determining the total number of subscribers and the gross amounts paid to the cable system for the basic service of providing secondary transmissions of primary broadcast transmitters, the system shall not include subscribers and amounts collected from subscribers receiving secondary transmissions for private home viewing pursuant to section 119."
For more information on when to exclude these amounts, see the note on page (vi) of the General Instructions.
During the accounting period did the cable system exclude any amounts of gross receipts for secondary transmissions made by satellite carriers to satellite home "dish" owners?
____ NO
____ YES. Enter the total here $_______________________ and list the satellite carrier(s) below.
Name _______________________
Mailing Address _______________________
_______________________
Name _______________________
Mailing Address _______________________
_______________________
Q Interest Assessment
WORKSHEET FOR COMPUTING INTEREST
You must complete this worksheet for those royalty payments submitted as a result of a late payment or underpayment. For an explanation of interest assessment, see page (vii) General Instructions.
Line 1. Enter the amount of late payment or underpayment $_______________________
x_______________________%
Line 2. Multiply line 1 by the interest rate* and enter the sum here _______________________
x_______________________ days
Line 3. Multiply line 2 by the number of days late _______________________ x .00274
Line 4, Multiply line 3 by .00274** enter here and on line 3, Block 4, space L, (page 7) $_______________________ (interest charge)
*Contact the Licensing Division at 202-707-8150 for the interest rate for the accounting period in which the late payment or underpayment occurred.
**This is the decimal equivalent of 1/365, which is the interest assessment for one day late.
NOTE: If you are filing this worksheet covering a Statement of Account already submitted to the Copyright Office, please list below the Owner, Address, First Community Served, and Accounting Period as given in the original filing.
Owner _______________________
Address _______________________
First Community Served _______________________
Accounting Period _______________________