Library of Congress · U.S. Copyright Office · Licensing Division · 101 Independence Avenue SE · Washington, DC 20557-6400 · www.copyright.gov/licensing
FORM REMITTANCE ADVICE – CABLE/SATELLITE
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09 ⁄ 2018
Privacy Act Notice: Sections 111 and 119 of title 17, United States Code, authorize the Copyright Oce to collect the personally identifying information (PII) requested on this form in order to process
your payment. PII is any personal information that can be used to identify or contact an individual, such as names, addresses, and telephone numbers. e Copyright Oce collects this PII in order to
allocate your payment by electronic funds transfer (EFT). By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes being available for public
inspection and being included in search reports prepared for the public. e eects of not providing the PII requested are that it may delay the allocation of your payment and its placement in the
completed record of statements of account, and it may aect the legal suciency of the ling, a determination that would be made by a court of law.
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