Library of Congress
Copyright Office
Licensing Division
101 Independence Avenue SE
Washington, DC 20557-6400

Penalty for Private Use $300


UNITED STATES COPYRIGHT OFFICE


(

)


Multicast versus Simulcast
Multicast is a digital stream of programming that is transmitted by a television broadcast station and is not the station’s
primary stream. Simulcast is a multicast stream of a television broadcast station that duplicates the programming
transmitted by the primary stream or another multicast stream of such station.
Photocopy Required
A legible copy of the semiannual statement of account must be submitted together with the original statement of
account to the Copyright Ofce.
Electronic Payment of Royalty Fees Required
Detailed instructions for making royalty payments via electronic funds transfer (EFT) are contained in circulars 74a,
74b, and 74c, which are available at www.copyright.gov/circs/circ74 or by contacting the Licensing Division (8:30 am
and 5:00 pm EST) by phone at (202) 707-8150, fax (202) 707-0905, or email licscal@loc.gov. The remittance must be
made payable to Register of Copyrights.
Remittance Advice Information
Federal regulations (C.F.R. Title 37 201.17 [i]) require that a remittance advice be attached to the statement(s) of
account, and a copy of the remittance advice be emailed or sent by facsimile to the Licensing Division. The Ofce uses
this remittance information to ensure the funds received via EFT are correctly allocated to each statement of account.
Filing an accurate advice (1) facilitates processing of your payments, (2) minimizes our contact or correspondence with
you, and (3) reduces administrative and other costs.
Convenient form at http://www.copyright.gov/licensing/remittance-advice.pdf.
Library of Congress
Copyright Ofce
Licensing Division
101 Independence Avenue SE
Washington, DC 20557-6400
Tel: (202) 707-8150 (8:30 a.m.–5:00 p.m., EST) Fax: (202) 707-0905
Email: licensing@loc.gov or Web: www.copyright.gov/licensing
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You are a click away from up-to-the
minute licensing updates.
NewsNet is a free electronic newsletter that
alerts subscribers to updates on licensing
regulations and procedures as well as forms
for compulsory and statutory licenses.
Here is how to subscribe to NewsNet:
Go to the licensing information page
on the Copyright Office website at
www.copyright.gov/licensing and click
on the subscribe link.
or
Use this link: www.copyright.gov/newsnet.
Have you subscribed
to NewsNet?
Have you tried pay.gov?
It's free
Pay.gov makes it easy and economical to make secure electronic
payments to the Register of Copyrights.
It's easy as 1-2-3
1.
If you are a registered user,
go directly to www.pay.gov
and log in.
If you are not already
registered, call (202)
707-8150 to establish an
account.
2.
Once you enter www.
pay.gov, click on Private
Forms under the Forms
list.
3.
Go to Royalty Fee
Collection to submit
your payment.
note:
Detailed instructions for using www.pay.
gov are available on the Copyright Office website
at www.copyright.gov/circs/circ74c.pdf.
sl-xx  rev: 03
2010  print: 03 
2010 – xx,000  Printed on recycled paper  U.S. Government Printing Office: 2010-357-993 ⁄ 80,069
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
If you are filing for a prior accounting period, contact the Licensing Division for the correct form.

for Secondary Transmissions by
Cable Systems (Long Form)
General instructions are at the
end of this form [pages i–viii].
FOR COPYRIGHT OFFICE USE ONLY
DATE RECEIVED
A


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.


(Number, street, rural route, apartment, or suite number)
(City, town, state, zip code)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
C


AMOUNT
ALLOCATION NUMBER
$
Form SA3c Rev: 12 2010


Return to:
Library of Congress
Copyright Ofce
Licensing Division
101 Independence Ave. SE
Washington, DC 20557-6400
(202) 707-8150
For courier deliveries,
see page ii of the general
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.
If there were different owners during the accounting period, only the owner on the last day of the accounting period should submit
a single statement of account and royalty fee payment covering the entire accounting period.
Check here if this is the system’s first filing. If not, enter the system’s ID number assigned by the Licensing Division. __________



1
2
3
(Number, street, rural route, apartment, or suite number)
(City, town, state, zip)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

January 1–June 30 . . . . . . . . . . . . . . .
July 1–December 31 . . . . . . . . . . . . . . .
(Year) (Year)


CITY OR TOWN
 For complete space D instructions, see page 1b. Identify only the first community served below and relist on page 1b with
all communities.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Below is a sample for reporting communities if you report multiple channel line-ups in Space G.
STATE
SUB GRP#



CITY OR TOWN (SAMPLE)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
STATE CH LINE UP

6
 Section 111 of title 17 of the United States Code authorizes the Copyright Office to collect the personally identifying information (PII) requested on this
form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address and telephone
numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Office's public indexes and in
search reports prepared for the public. The effects of not providing the PII requested is that it may delay processing of your statement of account and its placement in the
completed record of statements of account, and it may affect the legal sufficiency of the filing, a determination that would be made by a court of law.


6

LEGAL NAME OF OWNER OF CABLE SYSTEM:
FORM SA3. PAGE 1b. 
SUB GRP#


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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(dd). 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 lings.
 Entities and properties such as hotels, apartments, condominiums, or mobile home parks should be reported in parentheses below
the identified city or town.
If all communities receive the same complement of television broadcast stations (i.e., one channel line-up for all), then either associate
all communities with the channel line-up “A” in the appropriate column below or leave the column blank. If you report any stations
on a partially distant or partially permitted basis in the DSE Schedule, associate each relevant community with a subscriber group,
designated by a number (based on your reporting from Part 9).
When reporting the carriage of television broadcast stations on a community-by-community basis, associate each community with a
channel line-up designated by an alpha-letter(s) (based on your Space G reporting) and a subscriber group designated by a number
(based on your reporting from Part 9 of the DSE Schedule) in the appropriate columns below.
CITY OR TOWN STATE CH LINE UP


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LEGAL NAME OF OWNER OF CABLE SYSTEM:
FORM SA3. PAGE 2.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Service to first set
Service to additional set(s)
FM radio (if separate rate)



Residential
Non-residential

 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).
 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).
 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.
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.  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).”
 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 that 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 2
CATEGORY OF SERVICE
NO. OF
SUBSCRIBERS
BLOCK 1
BLOCK 2
CATEGORY OF SERVICE
CATEGORY OF SERVICE

Pay cable
Pay cable—add’l channel
Fire protection
•Burglar protection

First set
Additional set(s)
FM radio (if separate rate)
Converter
RATE
BLOCK 1

Motel, hotel
Commercial
Pay cable
Pay cable—add’l channel
Fire protection
Burglar protection

Reconnect
Disconnect
Outlet relocation
Move to new address
RATECATEGORY OF SERVICERATE
RATE RATECATEGORY OF SERVICE
NO. OF
SUBSCRIBERS





F






 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 or (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.
 Give the standard rate charged by the cable system for each of the applicable services listed.
 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.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LEGAL NAME OF OWNER OF CABLE SYSTEM:
FORM SA3. PAGE 3. 





 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.
 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 and 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.
 List each station’s call sign. Do not report origination program services such as HBO, ESPN, etc. Identify
each multicast stream associated with a station according to its over-the-air designation. For example, report multi-
cast stream as “WETA-2”. Simulcast streams must be reported in column 1 (list each stream separately; for example
WETA-simulcast).
 Give the channel number the FCC has assigned to the television station for broadcasting over-the-air in
its community of license. For example, WRC is Channel 4 in Washington, D.C. This may be different from the channel
on which your cable system carried the station.
 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), “N-M” (for network multicast), “I” (for independent), “I-M”
(for independent multicast), “E” (for noncommercial educational), or “E-M” (for noncommercial educational multicast).
For the meaning of these terms, see page (v) of the general instructions.
 If the station is outside the local service area, (i.e. “distant”), enter “Yes”. If not, enter “No”. For an ex-
planation of local service area, see page (v) of the general instructions.
 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.
For the retransmission of a distant multicast stream that is not subject to a royalty payment because it is the subject
of a written agreement entered into on or before June 30, 2009, between a cable system or an association representing
the cable system and a primary transmitter or an association representing the primary transmitter, enter the designa-
tion “E” (exempt). For simulcasts, also enter “E”. If you carried the channel on any other basis, enter “O.” For a further
explanation of these three categories, see page (v) of the general instructions.
 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.

If you are utilizing multiple channel line-ups, use a separate space G for each channel line-up.
1. CALL
SIGN
2. B’CAST
CHANNEL
NUMBER
3. TYPE
OF
STATION
4. DISTANT?
(Yes or No)
5. BASIS OF
CARRIAGE
(If Distant)
6. LOCATION OF STATION
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
LEGAL NAME OF OWNER OF CABLE SYSTEM:
FORM SA3. PAGE 4.




 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.
 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 the Copyright Office regulations on this point, see page (v) of the general instructions.
 Identify the call sign of each station carried.
 State whether the station is AM or FM.
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.
 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 CALL SIGN AM or FM S/D LOCATION OF STATION
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LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 5. 
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I





WHEN SUBSTITUTE
CARRIAGE OCCURRED
7. REASON
FOR
DELETION
1. TITLE OF PROGRAM
2. LIVE?
Yes or No
3. STATION’S
CALL SIGN 4. STATION’S LOCATION
5. MONTH
AND DAY
6. TIMES
FROM — TO
SUBSTITUTE PROGRAM

 In space I, identify every nonnetwork 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.

During the accounting period, did your cable system carry, on a substitute basis, any nonnetwork television program
broadcast by a distant station?
c

c

 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.

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.
 Give the title of every nonnetwork 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.”
 If the program was broadcast live, enter “Yes.” Otherwise enter “No.”
 Give the call sign of the station broadcasting the substitute program.
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).
 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.”
 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 “6:006:30 p.m.”
 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; enter the letter “P” if the listed pro-
gram was substituted for programming that your system was permitted to delete under FCC rules and regulations in
effect on October 19, 1976.
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
LEGAL NAME OF OWNER OF CABLE SYSTEM:
FORM SA3. PAGE 6.




 This space ties in with column 5 of space G. If you listed a station’s basis of carriage as “LAC” for part-
time carriage due to lack of activated channel capacity, you are required to complete this log giving the total dates and
hours your system carried that station. If you need more space, please attach additional pages.
 Give the call sign of every distant station whose basis of carriage you identified by “LAC” in
column 5 of space G.
 For each station, list the dates and hours when part-time carriage oc-
curred during the accounting period.
Give the month and day when the carriage occurred. Use numerals, with the month first. Example: for April 10 give
“4/10.”
State the starting and ending times of carriage to the nearest quarter hour. In any case where carriage ran to the end
of the television station’s broadcast day, you may give an approximate ending hour, followed by the abbreviation
“app.” Example: “12:30 a.m.–3:15 a.m. app.”
You may group together any dates when the hours of carriage were the same. Example: “5/10-5/14, 6:00 p.m.–
12:00 p.m.”
DATES AND HOURS OF PART-TIME CARRIAGE
WHEN CARRIAGE OCCURRED
WHEN CARRIAGE OCCURRED
DATE
CALL SIGN
HOURS
FROM TO
CALL SIGN
DATE
HOURS
FROM TO
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 7. 
 All cable systems with semiannual gross receipts of $527,600 or more are required to pay at
least the minimum fee, regardless of whether they carried any distant stations. This fee is 1.064 percent of the
system’s gross receipts for the accounting period.
Line 1. Enter the amount of gross receipts from space K
Line 2. Multiply the amount in line 1 by 0.01064
Enter the result here.
This is your minimum fee.

: Use the blocks in this space L to determine the royalty fee you owe:
Complete block 1, showing your minimum fee.
Complete block 2, showing whether your system carried any distant television stations.
If your system did not carry any distant television stations, leave block 3 blank. Enter the amount of the minimum
fee from block 1 on line 1 of block 4, and calculate the total royalty fee.
If your system did carry any distant television stations, you must complete the applicable parts of the DSE Schedule
accompanying this form and attach the schedule to your statement of account.
If part 8 or part 9, block A, of the DSE schedule was completed, the base rate fee should be entered on line 1 of
block 3 below.
If part 6 of the DSE schedule was completed, the amount from line 7 of block C should be entered on line 2 in block
3 below.
If part 7 or part 9, block B, of the DSE schedule was completed, the surcharge amount should be entered on line
2 in block 4 below.
Line 1. Enter either the minimum fee
from block 1 or the sum of the base rate fee / 3.75 fee from block 3, line 3,
whichever is larger
Line 2.  Enter the fee from either part 7
(block D, section 3 or 4) or part 9 (block B) of the DSE schedule. If none, enter
zero.
Line 3.  Enter the amount from line 4, space Q, page 9 (Interest
Worksheet)
 Add Lines 1, 2 and 3 of block 4 and enter total here
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Line 1 Enter the base rate fee from either part 8, section 3 or
4, or part 9, block A of the DSE schedule. If none, enter zero
Line 2.  Enter the total fee from line 7, block C, part 6 of the DSE
schedule. If none, enter zero
Line 3. Add lines 1 and 2 and enter
here
Block
 Your answer here must agree with the information you gave in
space G. If, in space G, you identified any stations as “distant” by stating “Yes” in column 4, you must check
“Yes” in this block.
• Did your cable system carry any distant television stations during the accounting period?
c
Yes—Complete the DSE schedule.
c
No—Leave block 3 below blank and complete line 1, block 4.

: 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 (vii) of the general instructions.
Gross receipts from subscribers for secondary transmission service(s)
during the accounting period.
 You must complete a statement in space P concerning gross receipts.
(Amount of gross receipts)
K

L


Block
1
2
Block
3
Block
4
. . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
$
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..........................................
$
Remit this amount via electronic payment payable to Register of Copyrights. (See page (i) of the
general instructions for more information.)
6
$
$
$
$
$












I I
I I
I I
I I

LEGAL NAME OF OWNER OF CABLE SYSTEM:
FORM SA3. PAGE 8.


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

 (Identify an individual to whom
we can write or call about this statement of account.)
Name
Address
Telephone
(Area code)
(Number, street, rural route, apartment, or suite number)
(City, town, state, zip)
 (This statement of account must be certified and signed in accordance with Copyright Office regu-
lations, as explained in the general instructions.)
I, the undersigned, hereby certify that (Check one, but only one, of the boxes.)
c
 I am the owner of the cable system as identified in line 1
of space B; or
c
 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
c
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:
Typed or printed name:
Title:
Date:
(Title of official position held in corporation or partnership)
O





. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Email (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fax (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 Section 111 of title 17 of the United States Code authorizes the Copyright Office to collect the personally identifying information (PII) requested on this
form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address and telephone
numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Office's public indexes and in
search reports prepared for the public. The effects of not providing the PII requested is that it may delay processing of your statement of account and its placement in the
completed record of statements of account, and it may affect the legal sufficiency of the filing, a determination that would be made by a court of law.
I
I
I I
(C
LEGAL NAME OF OWNER OF CABLE SYSTEM:
Name
FORM SA3. PAGE 9.
SPECIAL STATEMENT CONCERNING GROSS RECEIPTS EXCLUSIONS
The Satellite Home Viewer Act of 1988 amended Title 17, section 111(d)(1)(A), of the Copyright Act by adding the fol-
lowing 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 sub-
scribers and amounts collected from subscribers receiving secondary transmissions pursuant to section 119.”
For more information on when to exclude these amounts, see the note on page (vii) 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 dish owners?
c
NO
c
YES. Enter the total here and list the satellite carrier(s) below.
INTEREST ASSESSMENT
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 (viii) of the general instructions.
Line 3 Multiply line 2 by the number of days late and enter the sum here
Line 4 Multiply line 3 by 0.00274** enter here and on line 3, block 4,
space L, (page 7)
x %
x days
x 0.00274
(interest charge)
Line 1 Enter the amount of late payment or underpayment
Line 2 Multiply line 1 by the interest rate* and enter the sum here
Name
Mailing address
Q
Interest
Assessment
P
Special
Statement
Concerning
Gross Receipts
Exclusions
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name
Mailing address
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
. . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . .
*
To view the interest rate chart click on www.copyright.gov/licensing/interest-rate.pdf. For further assistance please
contact the Licensing Division at (202) 707-8150 or licensing@loc.gov.
** 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, accounting period, and ID number as given in the original
filing.
Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address .......................................................................................
.......................................................................................
First community served ..........................................................................
Accounting period ...............................................................................
ID number .....................................................................................
$
$
$
Privacy Act Notice: Section 111 of title 17 of the United States Code authorizes the Copyright Office to collect the personally identifying information (PII) requested on this
form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address and telephone
numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Office's public indexes and in
search reports prepared for the public. The effects of not providing the PII requested is that it may delay processing of your statement of account and its placement in the
completed record of statements of account, and it may affect the legal sufficiency of the filing, a determination that would be made by a court of law.
DSE SCHEDULE. PAGE 10.
All cable sys-
tems filing SA3 (Long Form) must pay at least the minimum fee, which is
1.064 percent of gross receipts. The cable system pays either the minimum
fee or the sum of the base rate fee and the 3.75 percent fee, whichever is
larger, and a Syndicated Exclusivity Surcharge, as applicable.
 A permitted station refers to a distant
station whose carriage is not subject to the 3.75 percent rate but is sub-
ject to the base rate and, where applicable, the Syndicated Exclusivity
Surcharge. A permitted station would include the following:
1) A station actually carried within any portion of a cable system prior
to June 25, 1981, pursuant to the former FCC rules.
2) A station first carried after June 24, 1981, which could have been
carried under FCC rules in effect on June 24, 1981, if such carriage
would not have exceeded the market quota imposed for the importa-
tion of distant stations under those rules.
3) A station of the same type substituted for a carried network, non-
commercial educational, or regular independent station for which a
quota was or would have been imposed under FCC rules (47 CFR
76.59 (b),(c), 76.61 (b),(c),(d), and 767.63 (a) [referring to 76.61 (b),(d)])
in effect on June 24, 1981.
4) A station carried pursuant to an individual waiver granted between
April 16, 1976, and June 25, 1981, under the FCC rules and regulations
in effect on April 15, 1976.
5) In the case of a station carried prior to June 25, 1981, on a part-time
and/or substitute basis only, that fraction of the current DSE repre-
sented by prior carriage.
 If your cable system carried a station that you believe qualifies
as a permitted station but does not fall into one of the above catego-
ries, please attach written documentation to the statement of account
detailing the basis for its classification.
 Under section 76.65 of the
former FCC rules, a cable system was not required to delete any station
that it was authorized to carry or was lawfully carrying prior to March 31,
1972, even if the total number of distant stations carried exceeded the
market quota imposed for the importation of distant stations. Carriage
of these grandfathered stations is not subject to the 3.75 percent rate,
but is subject to the Base Rate, and where applicable, the Syndicated
Exclusivity Surcharge. The Copyright Royalty Tribunal has stated its
view that, since section 76.65 of the former FCC rules would not have
permitted substitution of a grandfathered station, the 3.75 percent Rate
applies to a station substituted for a grandfathered station if carriage
of the station exceeds the market quota imposed for the importation
of distant stations.


Determine which distant stations were carried by the system pursuant
to former FCC rules in effect on June 24, 1981.
Identify any station carried prior to June 25, 198l, on a substitute and/or
part-time basis only and complete the log to determine the portion of
the DSE exempt from the 3.75 percent rate.
Subtract the number of DSEs resulting from this carriage from the num-
ber of DSEs reported in part 5 of the DSE Schedule. This is the total
number of DSEs subject to the 3.75 percent rate. Multiply these DSEs
by gross receipts by .0375. This is the 3.75 fee.


Determine if any portion of the cable system is located within a top 100
major television market as defined by the FCC rules and regulations in
effect on June 24, 1981. If no portion of the cable system is located in
a major television market, part 7 does not have to be completed.
Determine which station(s) reported in block B, part 6 are commercial
VHF stations and place a grade B contour, in whole, or in part, over the
cable system. If none of these stations are carried, part 7 does not have
to be completed.
Determine which of those stations reported in block b, part 7 of the
DSE Schedule were carried before March 31,1972. These stations are
exempt from the FCC’s syndicated exclusivity rules in effect on June 24,
1981. If you qualify to calculate the royalty fee based upon the carriage
of partially-distant stations, and you elect to do so, you must compute
the surcharge in part 9 of this schedule.
Subtract the exempt DSEs from the number of DSEs determined in block
B of part 7. This is the total number of DSEs subject to the Syndicated
Exclusivity Surcharge.
Compute the Syndicated Exclusivity Surcharge based upon these DSEs
and the appropriate formula for the system’s market position.


The term “distant signal equivalent” (DSE) generally refers to the numerical
value given by the Copyright Act to each distant television station carried
by a cable system during an accounting period. Your system’s total number
of DSEs determines the royalty you owe. For the full definition, see page
(v) of the General Instructions.

There are two different formulas for computing DSEs: (1) a basic formula
for all distant stations listed in space G (page 3), and (2) a special for-
mula for those stations carried on a substitute basis and listed in space
I (page 5). (Note that if a particular station is listed in both space G and
space I, a DSE must be computed twice for that station: once under the
basic formula and again under the special formula. However, a station’s
total DSE is not to exceed its full type-value. If this happens, contact the
Licensing Division.)


 For purposes of computing
DSEs, the Copyright Act gives different values to distant stations depend-
ing upon their type. If, as shown in space G of your statement of account
(page 3), a distant station is:
 its type-value is ........................................................1.00
 its type-value is ...............................................................0.25
 its type-value is .............................0.25
Note that local stations are not counted at all in computing DSEs.
  The DSE of
a station also depends on its basis of carriage. If, as shown in space G
of your Form SA3, the station was carried part time because of lack of
activated channel capacity, its basis of carriage value is determined by (1)
calculating the number of hours the cable system carried the station during
the accounting period, and (2) dividing that number by the total number of
hours the station broadcast over the air during the accounting period. The
basis of carriage value for all other stations listed in space G is 1.0.
Multiply the result of step 1 by the result of step 2. This gives
you the particular station’s DSE for the accounting period. (Note that for
stations other than those carried on a part-time basis due to lack of ac-
tivated channel capacity, actual multiplication is not necessary since the
DSE will always be the same as the type value.)


 For each station, calculate the number of programs that, during the
accounting period, were broadcast live by the station and were substituted
for programs deleted at the option of the cable system.
(These are programs for which you have entered “Yes” in column 2and
“P” in column 7 of space I.)
: Divide the result of step 1 by the total number of days in the
calendar year (365—or 366 in a leap year). This gives you the particular
station’s DSE for the accounting period.

In part 5 of this schedule you are asked to add up the DSEs for all of the
distant television stations your cable system carried during the accounting
period. This is the total sum of all DSEs computed by the basic formula
and by the special formula.

The total royalty fee is determined by calculating the minimum fee and
the base rate fee. In addition, cable systems located within certain televi-
sion market areas may be required to calculate the 3.75 fee and/or the
Syndicated Exclusivity Surcharge.  Distant multicast streams are not
subject to the 3.75 fee or the Syndicated Exclusivity Surcharge.
 If a cable system located in whole or in part within a
television market added stations after June 24, 1981, that would not have
been permitted under FCC rules, regulations, and authorizations (hereaf-
ter referred to as “the former FCC rules”) in effect on June 24, 1981, the
system must compute the 3.75 fee using a formula based on the number
of DSEs added. These DSEs used in computing the 3.75 fee will not be
used in computing the base rate fee and Syndicated Exclusivity Surcharge.
 Cable systems located in
whole or in part within a major television market, as defined by FCC rules
and regulations, must calculate a Syndicated Exclusivity Surcharge for the
carriage of any commercial VHF station that places a grade B contour, in
whole or in part, over the cable system that would have been subject to
the FCC’s syndicated exclusivity rules in effect on June 24, 1981.


Determine whether any of the stations you carried were partially distant—
that is, whether you retransmitted the signal of one or more stations to
subscribers located within the station’s local service area and, at the same
time, to other subscribers located outside that area.
If none of the stations were partially distant, calculate your base rate
fee according to the following rates—for the system’s permitted DSEs
as reported in block B, part 6 or from part 5, whichever is applicable.
First DSE 1.064% of gross receipts
Each of the second, third, and fourth DSEs 0.701% of gross receipts
The fifth and each additional DSE 0.330% of gross receipts

If any of the stations were partially distant:
1. Divide all of your subscribers into subscriber groups depending on
their location. A particular subscriber group consists of all subscribers who
are distant with respect to exactly the same complement of stations.
2. Identify the communities/areas represented by each subscriber group.
3. For each subscriber group, calculate the total number of DSEs of
that group’s complement of stations.
If your system is located wholly outside all major and smaller television
markets, give each station’s DSEs as you gave them in parts 2, 3, and 4
of the schedule; or
If any portion of your system is located in a major or smaller television
market, give each station’s DSE as you gave it in block B, part 6 of this
schedule.
4. Determine the portion of the total gross receipts you reported in space
K (page 7) that is attributable to each subscriber group.
5. Calculate a separate base rate fee for each subscriber group, using
(1) the rates given above; (2) the total number of DSEs for that group’s
complement of stations; and (3) the amount of gross receipts attributable
to that group.
6. Add together the base rate fees for each subscriber group to deter-
mine the system’s total base rate fee.
7. If any portion of the cable system is located in whole or in part within
a major television market, you may also need to complete part 9, block B
of the Schedule to determine the Syndicated Exclusivity Surcharge.
 There
are no printed continuation sheets for the schedule. In most cases, the
blanks provided should be large enough for the necessary information. If
you need more space in a particular part, make a photocopy of the page
in question (identifying it as a continuation sheet), enter the additional
information on that copy, and attach it to the DSE schedule.
 In computing DSEs on the DSE schedule, you may
round off to no less than the third decimal point. If you round off a DSE in
any case, you must round off DSEs throughout the schedule as follows:
When the fourth decimal point is 1, 2, 3, or 4, the third decimal remains
unchanged (example: .34647 is rounded to .346).
When the fourth decimal point is 5, 6, 7, 8, or 9, the third decimal is
rounded up (example: .34651 is rounded to .347).
The example below is intended to supplement the instructions for calculat-
ing only the base rate fee for partially distant stations. The cable system
would also be subject to the Syndicated Exclusivity Surcharge for partially
distant stations, if any portion is located within a major television market.

(Santa Rosa)
Gross receipts $310,000.00
DSEs 2.472
Base rate fee $6,497.20
$310,000 x .01064 x 1.0 = 3,298.40
$310,000 x .00701 x 1.472 =
3,198.80
Base rate fee $6,497.20

(Fairvale)
Gross receipts $120,000.00
DSEs 1.389
Base rate fee $1,604.03
$120,000 x .01064 x 1.0 = 1,276.80
$120,000 x .00701 x .389 = 327.23
Base rate fee $1,604.03

(Rapid City and Bodega Bay)
Gross receipts $170,000.00
DSEs 1.083
Base rate fee $1,907.71
$170,000 x .01064 x 1.0 = 1,808.80
$170,000 x .00701 x .083 = 98.91
Base rate fee $1,907.71
EXAMPLE:
COMPUTATION OF COPYRIGHT ROYALTY FEE FOR CABLE SYSTEM CARRYING PARTIALLY DISTANT STATIONS
In most cases under current FCC
rules, all of Fairvale would be within
the local service area of both stations
A and C and all of Rapid City and Bo-
dega Bay would be within the local
service ares of stations B, D, and E.
 









STATION DSE
A (independent) 1.0
B (independent) 1.0
C (part-time) 0.083
D (part-time) 0.139
E (network) 0.25
 2.472

CITY
Santa Rosa
Rapid City
Bodega Bay
Fairvale
OUTSIDE LOCAL
SERVICE AREA OF
Stations A, B, C, D ,E
Stations A and C
Stations A and C
Stations B, D, and E

 Total Gross Receipts $600,000.00
x .01064
$6,384.00
 $6,497.20 + $1,907.71 + $1,604.03 = $10,008.94
In this example, the cable system would enter $10,008.94 in space L, block 3, line 1 (page 7)
LEGAL NAME OF OWNER OF CABLE SYSTEM:





 list the call signs of all distant stations identified by the letter “O” in column 5
of space G (page 3).
 for each independent station, give the DSE as “1.0”; for each network or noncom-
mercial educational station, give the DSE as “.25.”
CATEGORY “O” STATIONS: DSEs
CALL SIGN DSE CALL SIGN CALL SIGNDSE DSE

• Add the DSEs of each station.
Enter the sum here and in line 1 of part 5 of this schedule.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GROSS RECEIPTS
FROM SUBSCRIBERS
$310,000.00
100,000.00
70,000.00
120,000.00
$600,000.00
DSE SCHEDULE. PAGE 11.
LEGAL NAME OF OWNER OF CABLE SYSTEM:

 Give the amounts from the boxes in parts 2, 3, and 4 of this schedule and add them to provide the total
number of DSEs applicable to your system.
1. Number of DSEs from part 2
2. Number of DSEs from part 3
3. Number of DSEs from part 4
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CATEGORY LAC STATIONS: COMPUTATION OF DSEs

 List the call sign of all distant stations identified by “LAC” in column 5 of space G (page 3).
 For each station, give the number of hours your cable system carried the station during the accounting period. This
figure should correspond with the information given in space J. Calculate only one DSE for each station.
 For each station, give the total number of hours that the station broadcast over the air during the accounting period.
 Divide the figure in column 2 by the figure in column 3, and give the result in decimals in column 4. This figure must
be carried out at least to the third decimal point. This is the “basis of carriage value” for the station.
For each independent station, give the “type-value” as “1.0.” For each network or noncommercial educational station,
give the type-value as “.25.”
 Multiply the figure in column 4 by the figure in column 5, and give the result in column 6. Round to no less than the
third decimal point. This is the station’s DSE. (For more information on rounding, see page (viii) of the general instructions.)
1. CALL
SIGN
2. NUMBER
OF HOURS
CARRIED BY
SYSTEM
3. NUMBER
OF HOURS
STATION
ON AIR
4. BASIS OF
CARRIAGE
VALUE
5. TYPE
VALUE
6. DSE
TOTAL NUMBER OF DSEs

Add the DSEs of each station.
Enter the sum here and in line 3 of part 5 of this schedule,

Add the DSEs of each station.
Enter the sum here and in line 2 of part 5 of this schedule,
2. NUMBER
OF
PROGRAMS
3. NUMBER
OF DAYS
IN YEAR
4. DSE1. CALL
SIGN
2. NUMBER
OF
PROGRAMS
4. DSE
3. NUMBER
OF DAYS
IN YEAR
1. CALL
SIGN
SUBSTITUTE-BASIS STATIONS: COMPUTATION OF DSEs

 Give the call sign of each station listed in space I (page 5, the Log of Substitute Programs) if that station:
Was carried by your system in substitution for a program that your system was permitted to delete under FCC rules and regula-
tions in effect on October 19, 1976 (as shown by the letter “P” in column 7 of space I); and
Broadcast one or morelive, nonnetwork programs during that optional carriage (as shown by the word “Yes” in column 2 of
space I).
 For each station give the number oflive, nonnetwork programs carried in substitution for programs that were deleted
at your option. This figure should correspond with the information in space I.
 Enter the number of days in the calendar year: 365, except in a leap year.
 Divide the figure in column 2 by the figure in column 3, and give the result in column 4. Round to no less than the third
decimal point. This is the station’s DSE (For more information on rounding, see page (viii) of the general instructions.)
DSE SCHEDULE. PAGE 12.















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
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


















66
666
6
LEGAL NAME OF OWNER OF CABLE SYSTEM:

Line 1: Enter the total number of DSEs from part 5 of this schedule
Line 2: Enter the sum of permitted DSEs from block B above
Line 3: Subtract line 2 from line 1. This is the total number of DSEs subject to the 3.75 rate.
(If zero, leave lines 4–7 blank and proceed to part 7 of this schedule)
Line 4: Enter gross receipts from space K (page 7)
Line 5: Multiply line 4 by 0.0375 and enter sum here
Line 6: Enter total number of DSEs from line 3
Line 7: Multiply line 6 by line 5 and enter here and on line 2, block 3, space L (page 7)
BLOCK A: TELEVISION MARKETS
 Block A must be completed.
In block A:
If your answer if “Yes,” leave the remainder of part 6 and part 7 of the DSE schedule blank and complete part 8, (page 16) of the
schedule.
If your answer if “No,” complete blocks B and C below.
Is the cable system located wholly outside of all major and smaller markets as defined under section 76.5 of FCC rules and regula-
tions in effect on June 24, 1981?
c
Yes Complete part 8 of the schedule—
c
No—Complete blocks B and C below.
BLOCK B: CARRIAGE OF PERMITTED DSEs
Column 1:
CALL SIGN
Column 2:
BASIS OF
PERMITTED
CARRIAGE
Column 3:
$
BLOCK C: COMPUTATION OF 3.75 FEE
List the call signs of distant stations listed in part 2, 3, and 4 of this schedule that your system was permitted to
carry under FCC rules and regulations prior to June 25, 1981. For further explanation of permitted stations, see the
instructions for the DSE Schedule. ( The letter M below refers to an exempt multicast stream as set forth in the
Satellite Television Extension and Localism Act of 2010.)
Enter the appropriate letter indicating the basis on which you carried a permitted station.
(Note the FCC rules and regulations cited below pertain to those in effect on June 24, 1981.)
A Stations carried pursuant to the FCC market quota rules [76.57, 76.59(b), 76.61(b)(c), 76.63(a) referring to
76.61(b)(c)]
B Specialty station as defined in 76.5(kk) (76.59(d)(1), 76.61(e)(1), 76.63(a) referring to 76.61(e)(1)
C Noncommerical educational station [76.59(c), 76.61(d), 76.63(a) referring to 76.61(d)]
D Grandfathered station (76.65) (see paragraph regarding substitution of grandfathered stations in the
instructions for DSE schedule).
E Carried pursuant to individual waiver of FCC rules (76.7)
*F A station previously carried on a part-time or substitute basis prior to June 25, 1981
G Commercial UHF station within grade-B contour, [76.59(d)(5), 76.61(e)(5), 76.63(a) referring to 76.61(e)(5)]
M Retransmission of a distant multicast stream.
List the DSE for each distant station listed in parts 2, 3, and 4 of the schedule.
*( For those stations identified by the letter “F” in column 2, you must complete the worksheet on page 14 of
this schedule to determine the DSE.)
2. PERMITTED
BASIS
3. DSE
1. CALL
SIGN
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. CALL
SIGN
1. CALL
SIGN
2. PERMITTED
BASIS
2. PERMITTED
BASIS
3. DSE 3. DSE


x 0.0375
x
DSE SCHEDULE. PAGE 13.
$
$









...........................................
--
...........................................
--
................................
--
..........................................................
--
.............................................................
--
...................................................................
--
.....................
1
LEGAL NAME OF OWNER OF CABLE SYSTEM:

Was any station listed in block B of part 7 carried in any commu-
nity served by the cable system prior to March 31, 1972? (refer
to former FCC rule 76.159)
 You must complete this worksheet for those stations identified by the letter “F” in column 2 of block B, part 6 (i.e., those
stations carried prior to June 25, 1981, under former FCC rules governing part-time and substitute carriage.)
Column 1: List the call sign for each distant station identified by the letter “F” in column 2 of part 6 of the DSE schedule.
Column 2: Indicate the DSE for this station for a single accounting period, occurring between January 1, 1978 and June 30, 1981.
Column 3: Indicate the accounting period and year in which the carriage and DSE occurred (e.g., 1981/1).
Column 4: Indicate the basis of carriage on which the stationwas carried by listing one of the following letters:
(Note that the FCC rules and regulations cited below pertain to those in effect on June 24, 1981.)
A—Part-time specialty programming: Carriage, on a part-time basis, of specialty programming under FCC rules, sections
76.59(d)(1),76.61(e)(1), or 76.63 (referring to 76.61(e)(1)).
B—Late-night programming: Carriage under FCC rules, sections 76.59(d)(3), 76.61(e)(3), or 76.63 (referring to
76.61(e)(3)).
S—Substitute carriage under certain FCC rules, regulations, or authorizations. For further explanation, see page (vi) of the
general instructions.
Column 5: Indicate the station’s DSE for the current accounting period as computed in parts 2, 3, and 4 of this schedule.
Column 6: Compare the DSE figures listed in columns 2 and 5 and list the smaller of the two figures here. This figure should be entered
in block B, column 3 of part 6 for this station.
 The information you give in columns 2, 3, and 4 must be accurate and is subject to verification from the designated
statement of account on file in the Licensing Division.
PERMITTED DSE FOR STATIONS CARRIED ON A PART-TIME AND SUBSTITUTE BASIS
3. ACCOUNTING
PERIOD
4. BASIS OF
CARRIAGE
5. PRESENT
DSE
6. PERMITTED
DSE
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 Block A must be completed.
In block A:
If your answer is “Yes,” complete blocks B and C, below.
If your answer is “No,” leave blocks B and C blank and complete part 8 of the DSE schedule.
Is any station listed in block B of part 6 the primary stream of a
commercial VHF station that places a grade B contour, in whole
or in part, over the cable system?






. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BLOCK B: Carriage of VHF/Grade B Contour Stations
DSE SCHEDULE. PAGE 14.
1. CALL
SIGN
2. PRIOR
DSE








c
No—Enter zero and proceed to part 8.
c
Yes—List each station below with its appropriate permitted DSE
BLOCK C: Computation of Exempt DSEs
TOTAL DSEs
CALL SIGN DSE CALL SIGN DSE
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c
No—Enter zero and complete block D.
TOTAL DSEs
CALL SIGN DSE CALL SIGN DSE
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c
Yes—List each station below with its appropriate permitted DSE
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BLOCK A: MAJOR TELEVISION MARKET
Is any portion of the cable system within a top 100 major television market as defined by section 76.5 of FCC rules
in effect June 24, 1981?
c
Yes—Complete blocks B and C .
c
No—Proceed to part 8
LEGAL NAME OF OWNER OF CABLE SYSTEM:
Name
Did your cable system retransmit the signals of any partially distant television stations during the accounting period?
c
Yes—Complete part 9 of this schedule.
c
No—Complete the applicable section below.
If the figure in section 2, line C is 4.000 or less, compute your surcharge here and leave section 3b blank. NOTE: If the DSE
is 1.0 or less, multiply the gross receipts by .00599 by the DSE. Enter the result on line A below.
A. Enter 0.00599 of gross receipts (the amount in section1)
B. Enter 0.00377 of gross receipts (the amount in section 1)
C. Subtract 1.000 from total permitted DSEs (the figure on
line C in section 2) and enter here
D. Multiply line B by line C and enter here
E. Add lines A and D. This is your surcharge.
Enter here and on line 2 of block 4 in space L (page 7)
Syndicated Exclusivity Surcharge
If the figure in section 2, line C is more than 4.000, compute your surcharge here and leave section 3a blank.
A. Enter 0.00599 of gross receipts (the amount in section 1)
B. Enter 0.00377 of gross receipts (the amount in section 1)
C. Multiply line B by 3.000 and enter here
D. Enter 0.00178 of gross receipts (the amount in section 1)
E. Subtract 4.000 from total DSEs (the figure on line C in section 2) and enter here
F. Multiply line D by line E and enter here
G. Add lines A, C, and F. This is your surcharge.
Enter here and on line 2, block 4, space L (page 7)
Syndicated Exclusivity Surcharge
A. Enter the total DSEs from block B of part 7
B. Enter the total number of exempt DSEs from block C of part 7
C. Subtract line B from line A and enter here. This is the total number of DSEs
subject to the surcharge computation. If zero, proceed to part 8.
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter the amount of gross receipts from space K (page 7)
SECTION 3: TOP 50 TELEVISION MARKET
BLOCK D: COMPUTATION OF THE SYNDICATED EXCLUSIVITY SURCHARGE
Section
1
Section
2
Is any portion of the cable system within a top 50 television market as defined by the FCC?
c
Yes—Complete section 3 below.
c
No—Complete section 4 below.
Section
3a
Did your cable system retransmit the signals of any partially distant television stations during the accounting period?
c
Yes—Complete part 9, of the Schedule.
c
No—Complete the following sections.
If the figure in section 2, line C is 4.000 or less, compute your surcharge here and leave section 4b blank. NOTE: If the DSE
is 1.0 or less, multiply the gross receipts by 0.003 by the DSE. Enter the result on line A below.
A. Enter 0.00300 of gross receipts (the amount in section 1)
B. Enter 0.00189 of gross receipts (the amount in section 1)
C.Subtract 1.000 from total permitted DSEs (the figure on line C in section 2)
and enter here
D. Multiply line B by line C and enter here
E. Add lines A and D. This is your surcharge.
Enter here and in line 2, block 4, space L (page 7)
Syndicated Exclusivity Surcharge
SECTION 4: SECOND 50 TELEVISION MARKET
Section
4a
Section
3b
7
Computation
of the
Syndicated
Exclusivity
Surcharge
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DSE SCHEDULE. PAGE 15.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
$
$
$
$
$
$
$
$
$
$
$
$
$
I I
I I
I I
I I
Name
LEGAL NAME OF OWNER OF CABLE SYSTEM:
If the figure in section 2, line C is more than 4.000, compute your surcharge here and leave section 4a blank.
A. Enter 0.00300 of gross receipts (the amount in section 1)
B. Enter 0.00189 of gross receipts (the amount in section 1)
C. Multiply line B by 3.000 and enter here
D. Enter 0.00089 of gross receipts (the amount in section 1)
E. Subtract 4.000 from the total DSEs (the figure on line C in
section 2) and enter here
F. Multiply line D by line E and enter here
G. Add lines A, C, and F. This is your surcharge.
Enter here and on line 2, block 4, space L (page 7)
Syndicated Exclusivity Surcharge
DSE SCHEDULE. PAGE 16.
Instructions:
You must complete this part of the DSE schedule for the SUM OF PERMITTED DSEs in part 6, block B; however, if block A of part
6 was checked “Yes,” use the total number of DSEs from part 5.
In block A, indicate, by checking “Yes” or “No,” whether your system carried any partially distant stations.
If your answer is “No,” compute your system’s base rate fee in block B. Leave part 9 blank.
If your answer is “Yes” (that is, if you carried one or more partially distant stations), you must complete part 9. Leave block B below
blank.
What is a partially distant station? A station is “partially distant” if, at the time your system carried it, some of your subscribers
were located within that station’s local service area and others were located outside that area. For the definition of a station’s “local
service area,” see page (v) of the general instructions.
Did your cable system retransmit the signals of any partially distant television stations during the accounting period?
c
Yes—Complete part 9 of this schedule.
c
No—Complete the following sections.
BLOCK A: CARRIAGE OF PARTIALLY DISTANT STATIONS
Section
4b
. . . . . . . . . . . . . . . . . . . . .
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7
Computation
of the
Syndicated
Exclusivity
Surcharge
8
Computation
of
Base Rate Fee
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter the amount of gross receipts from space K (page 7)
Enter the total number of permitted DSEs from block B, part 6 of this schedule.
(If block A of part 6 was checked “Yes,”
use the total number of DSEs from part 5.)
If the figure in section 2 is 4.000 or less, compute your base rate fee here and leave section 4 blank.
NOTE: If the DSE is 1.0 or less, multiply the gross receipts by 0.01064 by the DSE. Enter the result on line A below.
A. Enter 0.01064 of gross receipts
(the amount in section 1)
B. Enter 0.00701 of gross receipts
(the amount in section 1)
C. Subtract 1.000 from total DSEs
(the figure in section 2) and enter here
D. Multiply line B by line C and enter here
E. Add lines A, and D. This is your base rate fee. Enter here
and in block 3, line 1, space L (page 7)
Base Rate Fee
BLOCK B: NO PARTIALLY DISTANT STATIONS—COMPUTATION OF BASE RATE FEE
Section
1
Section
2
Section
3
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6666
6
I I
I I
LEGAL NAME OF OWNER OF CABLE SYSTEM:

 It is no longer necessary to report television signals on a system-wide basis. Carriage of television broadcast signals
shall instead be reported on a community-by-community basis (subscriber groups) if the cable system reported multiple channel
line-ups in Space G.
 If any of the stations you carried were partially distant, the statute allows you, in computing your base rate fee, to exclude
receipts from subscribers located within the station’s local service area, from your system’s total gross receipts. To take advantage
of this exclusion, you must:
 Divide all of your subscribers into subscriber groups, each group consisting entirely of subscribers that are distant to the same
station or the same group of stations.  Treat each subscriber group as if it were a separate cable system. Determine the number
of DSEs and the portion of your system’s gross receipts attributable to that group, and calculate a separate base rate fee for each
group.
Add up the separate base rate fees for each subscriber group. That total is the base rate fee for your system.
NOTE: If any portion of your cable system is located within the top 100 television market and the station is not exempt in part 7, you
must also compute a Syndicated Exclusivity Surcharge for each subscriber group. In this case, complete both block A and B below.
However, if your cable system is wholly located outside all major television markets, complete block A only.

 For each community served, determine the local service area of each wholly distant and each partially distant station you
carried to that community.
 For each wholly distant and each partially distant station you carried, determine which of your subscribers were located
outside the station’s local service area. A subscriber located outside the local service area of a station is distant to that station (and,
by the same token, the station is distant to the subscriber.)
Divide your subscribers into subscriber groups according to the complement of stations to which they are distant. Each
subscriber group must consist entirely of subscribers who are distant to exactly the same complement of stations. Note that a cable
system will have only one subscriber group when the distant stations it carried have local service areas that coincide.
 Block A contains separate sections, one for each of your system’s sub-
scriber groups.
In each section:
Identify the communities/areas represented by each subscriber group.
Give the call sign for each of the stations in the subscriber group’s complement—that is, each station that is distant to all of the
subscribers in the group.
If:
1) your system is located wholly outside all major and smaller television markets, give each station’s DSE as you gave it in parts 2,
3, and 4 of this schedule; or,
2) any portion of your system is located in a major or smaller televison market, give each station’s DSE as you gave it in block B,
part 6 of this schedule.
Add the DSEs for each station. This gives you the total DSEs for the particular subscriber group.
Calculate gross receipts for the subscriber group. For further explanation of gross receipts see page (vii) of the general instructions.
Compute a base rate fee for each subscriber group using the formula outline in block B of part 8 of this schedule on the preceding
page. In making this computation, use the DSE and gross recipts figure applicable to the particular subscriber group (that is, the
total DSEs for that group’s complement of stations and total gross receipts from the subscribers in that group). You do not need
to show your actual calculations on the form.
If the figure in section 2 is , compute your base rate fee here and leave section 3 blank.
A. Enter 0.01064 of gross receipts
(the amount in section 1)
B. Enter 0.00701 of gross receipts
(the amount in section 1)
C. Multiply line B by 3.000 and enter here
D. Enter 0.00330 of gross receipts
(the amount in section 1)
E. Subtract 4.000 from total DSEs
(the figure in section 2) and enter here
F. Multiply line D by line E and enter here
G. Add lines A, C, and F. This is your base rate fee.
Enter here and in block 3, line 1, space L (page 7)




Section
4
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .







for






DSE SCHEDULE. PAGE 17.
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I I

LEGAL NAME OF OWNER OF CABLE SYSTEM:
DSE SCHEDULE. PAGE 18.

 Use part 9, block A, of the DSE Schedule to establish subscriber groups to compute the base rate fee for wholly and
partially permitted distant signals. Write “Permitted Signals” at the top of the page. Note: One or more permitted signals in these
subscriber groups may be partially distant.
 Use a separate part 9, block A, to compute the 3.75 percent fee for wholly nonpermitted and partially nonpermitted distant
signals. Write “Nonpermitted 3.75 stations” at the top of this page. Multiply the subscriber group gross receipts by total DSEs by
.0375 and enter the grand total 3.75 percent fees on line 2, block 3, of space L. Important: The sum of the gross receipts reported
for each part 9 used in steps 1 and 2 must equal the amount reported in space K.
 Use part 9, block B, to compute a syndicated exclusivity surcharge for any wholly or partially permitted distant
signals from step 1 that is subject to this surcharge.

 Use part 9, Block A, of the DSE Schedule to report each distant multicast stream of programming that is transmitted from
a primary television broadcast signal. Only the base rate fee should be computed for each multicast stream. The 3.75 Percent Rate
and Syndicated Exclusivity Surcharge are not applicable to the secondary transmission of a multicast stream.
You must report but not assign a DSE value for
the retransmission of a multicast stream that is the subject of a written agreement
entered into on or before June 30, 2009 between a cable system or an association representing the cable system and a primary
transmitter or an association representing the primary transmitter.
LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 19. 
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COMMUNITY/ AREA
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Total DSEs
Gross Receipts Third Group
 Third Group
COMMUNITY/ AREA







for



 Add the  for each subscriber group as shown in the boxes above.
Enter here and in block 3, line 1, space L (page 7)
CALL SIGN DSE CALL SIGN DSE
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BLOCK A: COMPUTATION OF BASE RATE FEES FOR EACH SUBSCRIBER GROUP
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DSE CALL SIGN DSECALL SIGN
FOURTH SUBSCRIBER GROUP
Total DSEs
Gross Receipts Fourth Group
 Fourth Group
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Total DSEs
Gross Receipts Second Group
 Second Group
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total DSEs
Gross Receipts First Group
 First Group
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FIRST SUBSCRIBER GROUP SECOND SUBSCRIBER GROUP
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COMMUNITY/ AREA
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COMMUNITY/ AREA
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CALL SIGN CALL SIGN DSEDSE CALL SIGN DSE CALL SIGN DSE
THIRD SUBSCRIBER GROUP
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
$
$
$
$
$
$
$
$
I I I I
I I I I
I I

LEGAL NAME OF OWNER OF CABLE SYSTEM:
FORM SA3. PAGE 20.
Line 1: Enter the VHF DSEs
Line 2: Enter the Exempt DSEs
Line 3: Subract line 2 from line 1
and enter here. This is the
total number of DSEs for
this subscriber group
subject to the surcharge
computation
Line 1: Enter the VHF DSEs
Line 2: Enter the Exempt DSEs
Line 3: Subract line 2 from line 1
and enter here. This is the
total number of DSEs for
this subscriber group
subject to the surcharge
computation







for



BLOCK B: COMPUTATION OF SYNDICATED EXCLUSIVITY SURCHARGE FOR EACH SUBSCRIBER GROUP
If your cable system is located within a top 100 television market and the station is not exempt in Part 7, you mustalso compute a
Syndicated Exclusivity Surcharge. Indicate which major television market any portion of your cable system is located in as defined
by section 76.5 of FCC rules in effect on June 24, 1981:
c
First 50 major television market
c
Second 50 major television market

 In line 1, give the total DSEs by subscriber group for commercial VHF Grade B contour stations listed in block A, part 9 of
this schedule.
In line 2, give the total number of DSEs by subscriber group for the VHF Grade B contour stations that were classified as
Exempt DSEs in block C, part 7 of this schedule. If none enter zero.
 In line 3, subtract line 2 from line 1. This is the total number of DSEs used to compute the surcharge.
 Compute the surcharge for each subscriber group using the formula outlined in block D, section 3 or 4 of part 7 of this
schedule. In making this computation, use gross receipts figures applicable to the particular group. You do not need to show
your actual calculations on this form.
FIRST SUBSCRIBER GROUP


First Group
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SECOND SUBSCRIBER GROUP


Second Group
Line 1: Enter the VHF DSEs
Line 2: Enter the Exempt DSEs
Line 3: Subract line 2 from line 1
and enter here. This is the
total number of DSEs for
this subscriber group
subject to the surcharge
computation
THIRD SUBSCRIBER GROUP


Third Group
Line 1: Enter the VHF DSEs
Line 2: Enter the Exempt DSEs
Line 3: Subract line 2 from line 1
and enter here. This is the
total number of DSEs for
this subscriber group
subject to the surcharge
computation
FOURTH SUBSCRIBER GROUP


Fourth Group
. . . .
. . . . . .. . . . . .
. . .
. . . . . .
. . . . . . . . . . . .
. . . . . . . . . . . .. . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Add the surcharge for each subscriber group as shown
in the boxes above. Enter here and in block 4, line 2 of space L (page 7)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . .
. . .
. . . . . . . . . . . .
$
$
$
$
$
I I I I
I I I I
I I



You are the owner (or represent the owner) of a cable system; and
You are filing the semiannual statement of account required by the copyright law; and
Your system’s semiannual gross receipts for secondary transmissions (the figure you give in space K of the form) is
and
You are also depositing the required semiannual royalty fee with the Licensing Division of the Copyright Office.





Cable systems are subject to copyright liability for their use
of copyrighted material in “secondary transmissions” (the
retransmission of television and radio broadcasts to subscrib-
ers). Cable retransmissions of copyrighted programming are
subject to a system of “statutory licensing.” Among other
things, this means that twice a year the owner of a cable sys-
tem must send a statement of account, together with a royalty
fee, to the Licensing Division of the Copyright Office.

A primary stream is the single digital stream
of programming that, before June 12, 2009, was substantially
duplicating the programming transmitted by the television
broadcast station as an analog signal. If there is no stream,
then the primary stream is the single digital stream of pro-
gramming transmitted by the television broadcast station for
the longest period of time.
A primary transmitter is a television
or radio broadcast station licensed by the Federal Commu-
nications Commission, or by an appropriate governmental
authority of Canada or Mexico, that makes primary transmis-
sions to the public.
The term subscriber means a person or entity
that receives a secondary transmission service from a cable
system and pays a fee for the service, directly or indirectly,
to the cable system.
The term subscribe means to elect to become a
subscriber.
In providing copyright liability for cable systems, the law
draws a distinction between “primary transmissions” and
“secondary transmissions”:
A primary transmission is a trans-
mission made to the public by a transmitting facility whose
signals are being received and further transmitted by a
secondary transmission service, regardless of where or
when the performance or display was first transmitted.
In the case of a television broadcast station, the primary
stream and any multicast streams transmitted by the sta-
tion constitute primary transmissions.
A secondary transmission
is the basic service of retransmitting television and radio
broadcasts to subscribers. The statute requires all U.S.
cable systems, regardless of how many subscribers they
have or whether they are carrying any distant signals, to
pay some copyright royalties. However, instead of oblig-
ing cable systems to bargain individually for each copy-
righted program they retransmit, the law offers them the
opportunity to obtain a “statutory license” for secondary
transmissions.
 Secondary transmissions do not include trans-
missions originated by a cable system (including local
origination cablecasting, pay cable, program services,
background music services, and originations on leased
or access channels). Cable systems must negotiate for
the use of any copyrighted material in the programming
they originate, and their originations are not subject to
statutory licensing.


 Study the general information on these pages and read
through the detailed instructions in the statement of ac-
count form itself. Before you start completing the form,
make sure that you have collected all of the necessary
information and that you are using the right form.
 Fill out the statement of account form, giving all of the
required information about your cable system and about
the television and radio stations carried by it. Print the
information in black ink. If you need more space, use one
or more continuation sheets.
 Certify the statement of account by signing at space O.
The statement of account is not acceptable unless it bears
the original handwritten signature of one of the persons
indicated in space O as authorized to certify it under
Copyright Office regulations.
 Make an electronic payment (see note on page ii) in the
amount you have calculated in space L, to cover the
copyright royalty fee. See the Federal Register, August
10, 2006 (71 FR 45739) available at www.copyright.gov/
fedreg/2006/71fr45739.html. The remittance should be
payable to Register of Copyrights.
 Send the completed statement of account, and one leg-
ible copy of the statement of account, all continuation
sheets, and the DSE schedule, if required, to
Library of Congress
Copyright Ofce
Licensing Division
101 Independence Avenue, SE
Washington, DC 20557-6400
For courier deliveries, see www.copyright.gov/mail.html
for updated information.
 Pages consisting solely of instructions do not need
to be submitted.
 The Copyright Office will retain your statement of account
and make it a part of our public records. You should
therefore keep a copy of the entire statement, as filed, in
case you need it for future reference.
 For detailed instructions concerning electronic pay-
ments, contact the Licensing Division for Circular 74 which is
also available online at www.copyright.gov circs circ74.pdf.

In general, having a statutory license means that a cable sys-
tem can retransmit broadcast programming without violating
the copyright law, as long as it complies with certain paper-
work requirements and, twice a year, deposits a royalty fee
with the Copyright Office.
The cable system can, without negotiated licenses or
advance permission from copyright owners, retransmit
signals of any U.S. television or radio stations that it is
authorized to carry under FCC rules, regulations, or au-
thorizations (plus Mexican or Canadian stations in certain
cases); and
The cable system must file statements of account with the
Copyright Office and must also deposit a semiannual roy-
alty. The amount of the royalty, which is established under
a statutory formula, depends on the total of the system’s
gross receipts for secondary transmission
service.
Every six months, the cable system must send the Copy-
right Office a statement of account on this form, SA3 (Long
Form), or on SA1-2 (Short Form) (if the system’s gross re-
ceipts for the accounting period are less than $527,600).
Each semiannual statement of account must be accom-
panied by the deposit of a royalty fee covering retransmis-
sions during the preceding six months in the form of an
electronic payment payable to Register of Copyrights.

Most television and radio broadcasts contain copyrighted ma-
terial. Without a statutory license, a cable system would either
have to negotiate licenses for all copyrighted programming it
retransmits or run the risk of substantial civil (or, in some cases,
criminal) liability for multiple acts of copyright infringement.

Under the statute and Copyright Office regulations, retrans-
missions are subject to statutory licensing only if they are
made by cable systems.
 A “cable system” is defined as “a facility,
located in any State, territory, trust territory, or possession
of the United States, that in whole or in part receives signals
transmitted or programs broadcast by one or more televi-
sion broadcast stations licensed by the Federal Communi-
cations Commission, and makes secondary transmissions
of such signals or programs by wires, cables, microwave,
or other communications channels to subscribing members
of the public who pay for such service.” A system that meets
this definition is considered a cable system for copyright
purposes, even if the FCC excludes it from being consid-
ered a cable system because of the number or nature of its
subscribers or the nature of its secondary transmissions.
 An “individual” cable system is
defined generally as “each cable system recognized as a
distinct entity under the rules, regulations, and practices
of the Federal Communications Commission.” In addition,
two or more cable facilities are considered as one individual
cable system if either (a) the facilities are in contiguous
communities and are under common ownership or control,
or (b) the facilities operate from one headend. Thus, even
if they are owned by different entities, two cable facilities
will be considered as one individual cable system if they
share a common headend.


The statutory authority given to cable systems to retransmit
television and radio broadcasts under a statutory license is
limited in several ways:
 To repeat: a cable system’s statutory license
extends only to secondary transmissions (retransmissions).
It does not permit the system to make any originations of
copyrighted material without a negotiated license covering
that material.
 In general, to be sub-
ject to statutory licensing under the copyright law, a cable
retransmission must be simultaneous with the broadcast
being carried. As a rule, taping or other recording of the
program is not permitted. Taping for delayed retransmis-
sion is permissible only for some (not all) cable systems
located outside the 48 contiguous states, and, even in
these exceptional cases, there are further limitations and
conditions that the cable system must meet.
GENERAL INSTRUCTIONS, FORM SA3, PAGE (ii).
GENERAL INSTRUCTIONS, FORM SA3, PAGE (iii).
 The broadcast signals that a cable sys-
tem can carry under a statutory license are limited to those
that it is permitted to carry under FCC rules, regu- lations,
and authorizations. If signal carriage is in violation of FCC
requirements, the cable system may be subject under the
Copyright Act to a separate action for copyright infringe-
ment for each unauthorized retransmission.
 In general, the copyright law does not
permit a cable system to retransmit signals of foreign televi-
sion and radio stations under a statutory license. The only
exceptions have to do with the signals of certain Mexican
and Canadian stations. Unless foreign signals fall within
these exceptions, their carriage would not be authorized
under a statutory license, even if permissible under FCC
rules.
 Cable
systems are not permitted to alter the content of retransmit-
ted programs, or to change, delete, or substitute commer-
cials or station announcements in or adjacent to programs
being carried. There is only one exception: under
certain
circumstances, substitutions involving commercial adver-
tising market research may be permitted.

The statute establishes two six-month accounting periods
for purposes of computing the royalty fee and reporting the
information called for in the statement of account. The first
semiannual period runs from January through June, and the
second from July through December, of each calender year.
You must use these accounting periods whether or not they
coincide with the beginning or ending of your cable system’s
fiscal year.

Cable systems are given 60 days after the close of each ac-
counting period in which to file their statements of account
and royalty fees. The following are the two filing dates you
must observe each year.
For the January–June accounting period:File between
July 1 and August 29, inclusive;
For the July–December accounting period: File between
January 1 and March 1, inclusive.
If August 29 or March 1 falls on a weekend or federal
holiday, statements of account and royalty fees may be filed
on the next succeeding business day.
Statements of account and royalty fees received before
the end of the accounting period will not be accepted. State-
ments and fees received after the August 29 or March 1
deadlines will be accepted for whatever legal effect they
may have, if any. The Copyright Office takes no position as
to what this effect will be, and a cable system that files late
runs a substantial risk.

Refund requests must be received within 60 days of the
close of the filing period (by April 30 or October 28). Also,
refund requests for late and amended payments must be
received before the expiration of 60 days from the date of
receipt at the Copyright Office of the royalty payment that
is the subject of the request. The Debt Collection Improve-
ment Act of 1996 requires that refunds be made through
electronic funds transfer (EFT). Note: Late payments are
subject to interest assessment. See page (viii) of the gen-
eral instructions. Contact the Licensing Division for addi-
tional information.

For purposes of computing the semiannual royalty fee a cable
system must pay, the statute creates three brackets, depend-
ing upon the system’s gross receipts from subscribers for sec-
ondary transmissions during the accounting period:
  royalty fee of $52;
 
 royalty fee determined by a formula based on
percentage of gross receipts;
  royalty fee deter-
mined by a formula based on percentage of gross re-
ceipts and on the number of distant stations carried by
the system.
A cable system is required to deposit its semiannual roy-
alty fee with the Copyright Office at the time it files each
statement of account. The royalty must be made by elec-
tronic payment, and the related statement of account must
be filed by the appropriate deadline accompanied by a cover
letter (see circulars 74a, 74b, and 74c). The Copyright Of-
fice transfers these fees into a special fund, which is later
distributed to copyright owners as payment for the use of
their works by cable systems.

The law requires a cable system to file statements of ac-
count for two purposes:
To show the basis for the semiannual royalty fee the cable
system owes under its statutory license, and
To give the information needed to allocate royalty fees
among copyright owners.
Thus, some of the information you give on your statement
of account has nothing to do with computing your gross
receipts or deciding the amount of your royalty fee. Never-
theless, you are required to give the additional information in
order to provide the basis for the second phase of the statu-
tory license: the distribution of fees to copyright owners.
GENERAL INSTRUCTIONS, FORM SA3, PAGE (iv).


As long as a cable system keeps its statutory li-cense
in force by complying with the requirements of the new
copyright law, it is not obliged to negotiate individual
copyright licenses for retransmission of television and
radio broadcasts.
The following are among the various ways a cable
system can lose its statutory license: by failing to file
the statements of account or royalty fees; by taping for
delayed retransmission; by carrying signals in violation
of FCC requirements; by carriage of certain foreign
stations; and by altering programs or substituting com-
mercials.
Without a statutory license, a cable system can be sued
by a copyright owner for the full range of civil rem-
edies for copyright infringement, including injunctions,
actual damages and profits, or statutory damages (of
up to $150,000 in cases of willful infringement). The
statute also provides for criminal penalties in cases of
willful infringements for commercial purposes.


All of the information you give in a statement of account
must be an accurate presentation of the facts existing dur-
ing the accounting period covered by that statement (or, in
certain cases, on the last day of that period).
List all areas served, stations
carried, and certain substitute or part-time programs car-
ried at any time during the accounting period.
You should report the total of gross
receipts attributable to the particular accounting period in
space K. The figures requested in space M should be the
appropriate totals of channels for the entire period.
Even if items of information concern-
ing the owner, system, subscribers, or rates have changed
during the accounting period, your statement of account
does not need to reect the change. Give only the facts
existing on the last day of the accounting period. If there
were different owners during the accounting period, only
the owner on the last day of the accounting period should
submit a single statement of account and royalty fee pay-
ment covering the entire accounting period.
)
Stations Actually Carried.Make sure that space G lists all
the television stations your system actually carried at any
time during the accounting period (except as explained in
space G of the form). Do not list stations that were not in fact
carried during that period, even if the FCC has authorized
their carriage, and even if they were carried during earlier
accounting periods.
Low Power Television Stations
The Copyright Act in section 111(f) delineates the local
status of a low power television station as follows: “In
the case of a low power television station, as defined by
the rules and regulations of the Federal Communications
Commission, the ‘local service area of a primary transmitter’
comprises the area within 35 miles of the transmitter site,
except that in the case of such a station located in a stan-
dard metropolitan statistical area which has one of the 50
largest populations of all standard metropolitan statistical
areas (based on the 1980 decennial census of population
taken by the Secretary of Commerce), the number of miles
shall be 20 miles.”
This means that a low power television station carried by
a cable system within an area as defined above will be
considered “local.” A low power television station should
be identified as “distant” in column 4 of space G if it is
carried by your cable system in whole or in part beyond
the low power television station’s local service area.
Translator Stations
Translator stations must be listed. For copyright purposes, a
translator station is a primary transmitter not only of any pro-
grams it originally transmits but also of all the programming
it receives from its parent station and retransmits. Thus, if
your cable system carried signals emanating from a translator
station, you must list the translator station in space G. And, if
your system separately carried signals from both a translator
station and its “parent” station, both the translator and the
parent station should be identified.
  For any translator station listed
in space G, the type of station indicated in column 3 should
be that of the parent station.
  As explained
below in these general instructions for space G, a television
station is considered a distant station if the cable system is
carrying the station wholly or partly beyond that station’s
local service area. The determination of whether a transla-
tor station should be identified as distant in column 4 of
space G depends on the local service area of the translator,
not that of the parent station.
Multicast stream. A multicast stream is a digital stream of
programming that is transmitted by a television broadcast
station and is not the station’s primary stream.
Simulcast. A simulcast is a multicast stream of a television
broadcast station that duplicates the programming trans-
mitted by the primary stream or another multicast stream of
such station.
Denitions of Types of Stations.Under the Copyright Act,
the terms used in connection with column 3 of space G
mean the following:
GENERAL INSTRUCTIONS, FORM SA3, PAGE (v).
  A primary stream of a television broad-
cast station that is owned or operated by, or affiliated with,
one or more of the television networks in the United States
providing nationwide transmissions, and that transmits
a substantial part of the programming supplied by such
networks for a substantial part of the primary stream’s
typical broadcast day.
The term network station also applies to a multicast
stream on which a television broadcast station transmits
all or substantially all of the programming of an intercon-
nected program service that is owned or operated by,
or affiliated with, one or more of the television networks
described above and offers programming on a regular
basis for 15 or more hours per week to at least 25 of
the affiliated television licensees of the interconnected
program service in 10 or more states.
  A primary stream or multicast stream
of a television broadcast station that is not a network station
or a noncommercial educational station. For purposes of
determining a station’s type-value this category includes
all specialty, Canadian and Mexican stations.
  A primary or mul-
ticast stream of a television broadcast station that is a
noncommercial educational broadcast station which is
owned and operated by a public agency or nonprofit pri-
vate foundation, corporation, or association; or owned
and operated by a municipality and which transmits only
noncommercial programs for educational purposes.
  In general,
the ‘local service area of a primary transmitter’, in the case
of both the primary stream and any multicast streams
transmitted by a primary transmitter that is a television
broadcast station, comprises the area where such pri-
mary transmitter could have insisted upon its signal being
retransmitted by a cable system pursuant to rules, regula-
tions, and authorizations of the FCC in effect on April 15,
1976. Effective July 1, 1994, a station’s local service area
also includes the station’s television market as defined in
section 76.55(e) of title 47, Code of Federal Regulations
(as in effect on September 18, 1993), or any modifications
to such television market made on or after September 18,
1993, pursuant to section 76.55(e) or 76.59 of title 47 of
the Code of Federal Regulations or within the noise-limited
contour as defined in 73.622(e)(1) of title 47, Code of Federal
Regulations. For the full definition see Section 111 (f) of the
Copyright Act.
Basis of Carriage of Distant Stations. In column 5 of space
G you are asked to identify the basis on which you carried
the signals of distant television stations during the account-
ing period. The three categories are as follows:
LAC Part-Time Carriage Because of Lack of Activated
Channel Capacity.In referring to this category, the Copy-
right Act speaks of “a station carried on a part-time basis
where full-time carriage is not possible because the cable
system lacks the activated channel capacity to retransmit
on a full-time basis all signals which it is authorized to carry.”
A cable system can only claim lack of activated channel
capacity (LAC) in column 5, space G if (a) all of its activated
television channels are used exclusively for the secondary
transmission of television signals, and (b) the number of
primary television transmitters secondarily transmitted by
the cable system exceeds the number of its activated tele-
vision channels.
“E” Exempt for Multicast Stream. This category covers the
retransmission of a multicast stream that is the subject
of a written agreement entered into on or before June 30,
2009, between a cable system or association representing
the cable system and a primary transmitter or an associa-
tion representing the primary transmitter. This category
also covers simulcast streams.
“O” Any other basis of carriage.This category covers all
distant television stations you carried, including full-time
stations, except:
those identified in category LAC above;
those identified in category “E” above;
those carried only on a substitute basis (see the general
instructions regarding the use of space I); and
those carried only on a part-time network basis under
former FCC rules cited in space G of the form.
 Simulcast streams are not subject to a royalty payment.


1 Due to changes in FCC rules, it is no longer
possible for cable systems to specify part-time
carriage of specialty and late-night program-
ming. Carriage by your cable system on either of
those bases must now be included in category
“O” cited above.
2 The “basis of carriage” to be identified in column
5 does not include substitute carriage. If a sta-
tion was carried only on a substitute basis, you
need not list it in space G but you must list it in
space I. A station carried on a substitute basis,
and also on some other basis, must be logged
in space G and space I.
3 A part-time carriage log (space J) must be pro-
vided for stations carried on a LAC basis.
Distant Signal Equivalent:
The distant signal equivalent (DSE) is the value assigned to
the secondary transmission of any non-network television
programming carried by a cable system in whole or in part
beyond the local service area of the primary transmitter. The
DSE is computed by assigning a value of one to each primary
stream and to each multicast stream (other than a simulcast)
that is an independent station, and
by assigning a value of
one-quarter to each primary stream and to each multicast
stream (other than a simulcast) that is a network station or
a noncommercial educational station.
GENERAL INSTRUCTIONS, FORM SA3, PAGE (vi).


A royalty payment shall be made for the retransmission of
non-network television programming carried on each multi-
cast stream of a distant digital television signal if such stream
was first retransmitted by a cable system on or after February
27, 2010.
Please list all of the multicast streams that the cable system
carried during the accounting period.
Assign a DSE value to each multicast stream that the cable
system began to retransmit on or after February 27, 2010.
Do not assign a DSE value for the retransmission of a
multicast stream that is the subject of a written agreement
entered into on or before June 30, 2009, between a cable
system or an association representing the cable system
and a primary transmitter or an association representing
the primary transmitter.
:
No royalties payments shall be made for a distant multicast
stream that “simulcasts” (i.e., duplicates) a primary stream
or another multicast stream of the same station that the
cable system is carrying.
Distant multicast streams shall not be subject to the 3.75%
fee or the syndicated exclusivity surcharge.
Cable operators are not entitled to refunds, or offsets, for
the retransmission of any distant multicast stream carried
prior to the 2010/1 accounting period.
)
All-Band Carriage. If your system carried FM radio stations
on an all-band basis, you are not required to list every sta-
tion that subscribers might possibly have received during
the accounting period. Instead, Copyright Office regulations
require you to monitor your FM transmission service at your
system’s headend from time to time during the accounting
period and to report the generally receivable FM stations
identified as a result of your monitoring.
Stations Generally Receivable. There are two standards for
determining whether an FM station is “generally receivable”:
1 Is the station usually carried whenever it is received at
your system’s headend; and
2 Can the station be expected to be received at the head-
end, with your system’s FM antenna at least three con-
secutive hours each day at the same time each day, five
or more days a week, for four or more weeks during any
calendar quarter, with a strength of not less than 50 mi-
crovolts per meter measured at the foot of the tower or
pole to which the antenna is attached?
The monitoring arrangements you set up should be aimed
at determining what stations can reasonably be expected
to meet these standards.
Monitoring Activities. It is not necessary to monitor con-
tinuously throughout the accounting period, and you are not
required to make precise measurements to determine which
stations in fact meet the technical standards and which do
not. Your monitoring activities should take place periodi-
cally at your headend during the accounting period and you
should use a good FM receiver.


Substitute Programs Must Be Logged and Reported.The
Copyright Act requires all cable systems to submit, with their
statement of account, logs showing the times, dates, sta-
tions, and programs involved in any nonnetwork television
programming that was carried in whole or in part beyond
the local service area of the primary transmitter under rules,
regulations, or authorizations of the FCC permitting the sub-
stitution or addition of signals under certain circumstances.
The applicable present and former rules and regulations are
identified in item 3, which follows.
What Programs Must Be Listed. You must list a program
in space I if all three of the following conditions apply:
  A
“nonnetwork television program” is a program that was not
being broadcast by a station as part of a network television
broadcast at the time the cable system carried it.
  A
“distant station” is a television station carried by a cable
system in whole or in part beyond that station’s local
service area. For the definition of “local service area,” see
the “Distant Station” section on page iv of the general
instructions.
 


Where FCC rules and regulations in effect on the date
of carriage require the deletion of certain programming
of one station and permit substitution of programming
from another distant station. That is, if a cable system
is required to delete a station because of FCC program
or sports exclusivity rules.
Where the FCC rules, regulations, and authorizations in
effect on October 19, 1976, permit a cable system at its
option to delete programming and authorize the system
to substitute programming from another distant station.
That is, if the cable system elects to delete a distant
station while that station is broadcasting a program
primarily of local interest to the distant community, for
copyright purposes former FCC rules sections 76.61(b)
(2) and 76.63 [incorporating 76.61(b)(2)] continue to
authorize the station to substitute the programming
of any other distant station.

1 The provisions of the Copyright Act dealing with volun-
tary deletion and substitution of programs are limited to
GENERAL INSTRUCTIONS, FORM SA3, PAGE (vii).
47 of the Code of Federal Regulations, to establish
and operate a channel of communications for point-to-
multipoint distribution of television station signals, and
that owns or leases a capacity or service on a satellite
in order to provide such point-to-multipoint distribution,
except to the extent that such entity provide such distri-
bution pursuant to tariff under the Communications Act
of 1934, other than for private home viewing pursuant to
Section 119.”
As provided in the Satellite Home Viewer Act [amend-
ment of section 111(d)(1)(A)], any amounts collected by
a cable system or distributor from subscribers should
be excluded from the cable system’s determination of
gross receipts received for the basicservice of providing
secondary transmissions of primary broadcast transmit-
ters pursuant to the cable compulsory license, section
111 (c) to (f). This provision contemplates the situation
where the same entity may be offering both satellites and
cable distribution of secondary transmissions of primary
broadcast transmitters.
If a cable system offers both satellite and cable services to
satellite dish owners, then it may exclude those amounts
attributed to the satellite service under section 119 of the
act. Such a system should declare on page 9 the amount
of gross receipts that are excluded for this service and list
the name and address of each satellite carrier in which
the system has contracted as a distributor or agent to
market the carrier’s retransmissions service. The system
should also maintain separate records of the subscriber
fees received for satellite carrier retransmissions.
Accrual Basis. If your revenue accounts are kept on an ac-
crual basis, the figure you give in space K should be the total
of all gross receipts for secondary transmission service ac-
crued for the accounting period. Subtract bad debts actually
written off during the period and add previously written-off
debts that were actually recovered during the period. (How-
ever, do not make adjustments for bad debts for second-
ary transmission service furnished before January 1, 1978.)
Cash Basis. If your revenue accounts are kept on a cash
basis, your gross receipts are all amounts actually received
during the accounting period for secondary transmission
service.
)
The method for calculating your royalty fee depends upon
whether your system carried any distant stations and, if so,
the number you carried. If the system did not carry any dis-
tant stations, you pay a minimum fee, which is calculated
in space L.
If the system carried any distant stations, you must com-
pute distant signal equivalents (DSEs) in parts 1 through 5
of the DSE schedule accompanying this form. Each cable
system regardless of whether or not it is located in a televi-
sion market area must compute a base rate fee if it carried
any distant stations. This figure is computed in part 8 of the
DSE schedule and is entered in block 3 of space L. (NOTE:
programs substituted under FCC rules, regulations, and
authorizations in effect on October 19, 1976.
2 Effective January 1, 1990, the FCC amended Parts 73
and 76 of its rules relating to program exclusivity in the
cable and broadcast industries.








)
What Are Gross Receipts?The gross receipts you enter in
secondary transmissions of primary broadcast transmitters.
They include the full amount of monthly (or other periodic)
service fees for any and all services or tiers of services that
include one or more secondary transmissions of television
or radio broadcast signals, for additional set fees, and for
converter fees. All such gross receipts shall be aggregated
and the DSE calculations shall be made against the aggre-
gated amount. Gross receipts for secondary transmission
services do not include installation (including connection,
relocation, disconnection or reconnection) fees; separate
charges for security, alarm, or facsimile services; charges
for late payments; or charges for pay cable or other program
origination services provided that the origination services
are not offered in combination with secondary transmission
service for a single fee.

The Satellite Home Viewer Act of 1988, Public Law 100-
667, as amended by Public Law 103-369, Public Law
106-113, Public Law 108-447, and Public Law 111-175,
establishes a statutory license for certain secondary trans-
missions made by satellite carriers to satellite dish owners.
Satellite carriers are subject to copyright liability for their
use of copyrighted material when they make secondary
transmissions (retransmissions of television broadcasts)
to satellite dish owners and they make a direct or indirect
charge for that service. Satellite carrier retransmissions
of the copyrighted programming embodied in the signals
of non-network stations or network stations are eligible
under an operational system of statutory licensing that is
established in section 119 of the Copyright Act.
A satellite carrier is defined in the Satellite Home Viewer
Extension and Reauthorization Act of 2004 as “an entity
that uses the facilities of a satellite or satellite service
licensed by the Federal Communications Commission,
and operates in the Fixed-Satellite Service under part
25 of title 47 of the Code of Federal Regulations or the
Direct Broadcast Satellite Service under part 100 of title
GENERAL INSTRUCTIONS, FORM SA3, PAGE (viii).
Unless the system is located totally outside of all television
markets, part 8 cannot be completed until parts 6 and 7
have been completed.) If any portion of the cable system is
located within a television market area as defined by the FCC
and that system carried any nonpermitted distant television
stations, then you must compute the 3.75 fee in part 6 of the
DSE schedule. This figure is to be entered on line 2, block 3
of space L. The base rate fee and the 3.75 percent fee are
then added together and the sum compared to the minimum
fee. Either the minimum fee or the sum of the base rate fee
and the 3.75 percent fee (whichever is greater) is listed on
line 1, block 4.
Additionally, if any portion of the cable system is located
within a top 100 major market area as defined by the FCC
and that system carried any distant stations, then you may
need to compute the Syndicated Exclusivity Surcharge in
part 7 of the DSE schedule. This figure is to be entered on
line 2, block 4 of space L. The total copyright royalty fee due
is computed in block 4 of space L by adding together (1)
the minimum fee or the sum of the base rate fee/3.75
per-
cent
fee (whichever is greater), (2) the Syndicated Exclusivity
Surcharge, and (3) the interest charge.
 In computing DSEs on the DSE
schedule, you may round off to no less than the third decimal
point. If you round off a DSE in any case, you must round
off DSEs throughout the schedule as follows:
When the fourth decimal point is 1, 2, 3, or 4, the third
decimal remains unchanged—(example: .34647 is round-
ed to .346)
When the fourth decimal point is 5, 6, 7, 8, or 9, the third
decimal is rounded up—(example: .34651 is rounded to
.347)
 Cable systems submitting additional deposits under
Section 111(d)(7) should contact the Licensing Division for
the appropriate form for submitting the additional fees.


Underpayments or late payments received after the filing
deadline shall be subject to an interest assessment. Cable
systems must calculate their own interest charge. (A work-
sheet is provided at space Q, page 9.) The interest rate set
for a specific accounting period is the U.S. Treasury Current
Value of Funds Rate in effect on the first business day after
the close of the filing deadline for that accounting period.
Cable systems may obtain the interest rate for the applicable
accounting period(s) by calling the Licensing Division at (202)
707-8150 or by clicking on to www.copyright.gov/licensing/
interest-rate.pdf.
For underpayments and late payments the interest shall
begin to accrue on the first day after the close of the filing
date for that accounting period.
The accrual period ends
on the date that the remittance is received in the Copyright
Office.
 The Office shall not require, nor notify a cable
system of, an interest charge of $5.00 or less.
GENERAL INSTRUCTIONS, FORM SA3, PAGE (ix).
GENERAL INSTRUCTIONS, FORM SA3, PAGE (x).
GENERAL INSTRUCTIONS, FORM SA3, PAGE (xi).