Text extracted from the exhibit documents filed with the FCC. Open a document above to read the original.
htps://www.fcc.gov/supplychain/coveredlist FCC Part 2.911 (d)(5)(i) and 2.911(d)(5)(ii) Attestations Date: Dec 5, 2025 Federal Communications Commission 7435 Oakland Mills Road Columbia, MD 21046 Attn: Reviewing Engineer FCC ID: 2BO3LLGSBTN65 Statement for 47 CFR section 2.911(d)(5)(i) LG Electronics Inc. certifies that as of the date of the application the equipment for which authorization is sought is not “covered” equipment prohibited from receiving an equipment authorization pursuant to section 2.903 of the FCC rules. Statement for 47 CFR section 2.911(d)(5)(ii) LG Electronics Inc. (“the applicant”) certifies that, as of the date of the filing of this application, the applicant is not identified on the Covered List (as a specifically named entity or any of its subsidiaries or affiliates – see KDB 986446 Question 5) as an entity producing “covered” equipment. LG Electronics Inc. (“the applicant”) certifies that, the device does not have cybersecurity and/or anti-virus software produced by Kaspersky Lab, Inc. or any of its successors and assignees, identified on the Covered list installed on the device, nor will it be installed by the applicant anytime after certification. Sincerely, Signed by: ____________________________ Name: Yongdeok Kwon Title: Professional Company Name: LG Electronics Inc. Company Address: 222 LG-ro, Jinwi-myeon, Pyeongtaek-si, Gyeonggi-do 17709, South Korea Contact Phone: 82-31-8066-5538 Email: [email protected]
Date: December 9, 2025 FCC ID: 2BO3LL GSBTN65 FCC Part 15.212 Requirements: ItemYesNoComments 1 This module has the own shielding on transmitter. 2 This module has the buffered modulation/data inputs. 3 The main RF chipset (nRF52820) of the module has its own power management unit, which enables the internal regulator and clock circuits. 4 This module has permanently attached antenna on the module PCB. 5 The test was performed in a stand-alone configuration without any host product. 6 The FCC label is printed on the PCB board silkscreen. 7 This module complies with all specific rules and operating requirements. 8 This module complies with the RF Exposure requirements.(<20cm) If a module does NOT meet one or more of the above listed requirements, the applicant may request Limited Modular Approval (LMA). Signed by: Name: Yongdeok Kwon T itle: Professional Email Address: [email protected] Phone Number:82-31-8066-5538 Address: FCC Modular Approval Attestation Please state details about how the following requirements could or could NOT be met; and state how control of the end product, into which the module will be installed, will be maintained by the applicant/manufacturer, such that full compliance of the end product is always ensured. ■ Single Modular Approval ☐ Single Limited Modular Approval (LMA) ☐ Split Modular Approval ☐ Split Limited Modular Approval (LMA) 222 LG-ro, Jinwi-myeon, Pyeongtaek-si, Gyeonggi-do 17709, South Korea 15.212 (a)(1)(i): The radio elements of the modular transmitter must have their own shielding. The physical crystal and tuning capacitors may be located external to the shielded radio elements. 15.212 (a)(1)(ii): The modular transmitter must have buffered modulation/data inputs (if such inputs are provided) to ensure that the module will comply with part 15 requirements under conditions of excessive data rates or over-modulation. 15.212 (a)(1)(ii): The modular transmitter must have its own power supply regulation. 15.212 (a)(1)(iv): The modular transmitter must comply with the antenna and transmission system requirements of §§ 15.203, 15.204(b) and 15.204(c). The antenna must either be permanently attached or employ a “unique” antenna coupler (at all connections between the module and the antenna, including the cable). The “professional installation” provision of § 15.203 is not applicable to modules but can apply to limited modular approvals under paragraph (b) of this section. 15.212 (a)(1)(v): The modular transmitter must be tested in a stand-alone configuration. 15.212 (a)(1)(vi): The modular transmitter must be labeled with its own FCC ID number. 15.212 (a)(1)(vii): The modular transmitter must comply with any specific rule or operating requirements applicable to the transmitter and the manufacturer must provide adequate instruction along with the module to explain any such requirements. 15.212 (a)(1)(viii): The modular transmitter must comply with any applicable RF exposure requirements. §15.212 Requiremnets
Date: May 12, 2025 Rev: 0.1 HACS-F039 U.S. Agent for Service of Process Attestation HCT America, Inc. ([email protected]) 840 Yosemite Way, Milpitas, CA 95035 TEL: +1.510.933.8848, Fax: +1.510.933.8849 Page 1 of 3 This document is electronically controlled. Hard copy documents are uncontrolled. Please check all hard copies against the controlled electronic copy to ensure validity. This document is the confidential property of HCT AMERICA, INC. It may not be forwarded or reproduced in whole or in part without written permissions from HCT AMERICA, INC. U.S. Agent for Service of Process Attestation Date: May 12, 2025 Rev: 0.1 HACS-F039 U.S. Agent for Service of Process Attestation HCT America, Inc. ([email protected]) 840 Yosemite Way, Milpitas, CA 95035 TEL: +1.510.933.8848, Fax: +1.510.933.8849 Page 2 of 3 This document is electronically controlled. Hard copy documents are uncontrolled. Please check all hard copies against the controlled electronic copy to ensure validity. This document is the confidential property of HCT AMERICA, INC. It may not be forwarded or reproduced in whole or in part without written permissions from HCT AMERICA, INC. REVISION TABLE Rev Description of Change Date Approved 0.0 Original Release 07/15/2024 QM 0.1 Update Address 05/12/2025 QM Date: May 12, 2025 Rev: 0.1 HACS-F039 U.S. Agent for Service of Process Attestation HCT America, Inc. ([email protected]) 840 Yosemite Way, Milpitas, CA 95035 TEL: +1.510.933.8848, Fax: +1.510.933.8849 Page 3 of 3 This document is electronically controlled. Hard copy documents are uncontrolled. Please check all hard copies against the controlled electronic copy to ensure validity. This document is the confidential property of HCT AMERICA, INC. It may not be forwarded or reproduced in whole or in part without written permissions from HCT AMERICA, INC. FCC Part 2.911(d)(7) Attestation U.S. Agent for Service of Process Fed eral Communications Commission 7435 Oakland Mills Road Columbia, MD 21046 Attn: Reviewing Engineer Applicant Information: Company Name: LG Electronics Inc. Contact Name: Yongdeok Kwon Company Address: 222 LG-ro, Jinwi-myeon, Pyeongtaek-si, Gyeonggi-do 17709, South Korea Contact Phone Number: 82-31-8066-5538 Email: [email protected] FRN: 0036977056 A pplicant Signature: __________________ Signed by (Printed Name/Title): Yongdeok Kwon/Professional Date: December 9, 2025 LG Electronics Inc. (“the applicant”) as required by section 2.911(d)(7), designates th e f ollowing agent, located in the Uni ted States, for purposes of acting as the applicant’s agent for service of proc ess. The applicant acknowledges that they will maintain an agent for no less than one year after the grantee has terminated all marketing and importation or the conclusion of any Commission- related proceeding involving the equipment. The applicant further acknowledges their responsibility to inform the FCC whenever the agent information changes. U. S. Agent Information: C ompany Name: LG Electronics USA, Inc. C ontact Name: Heejae Cho Company Address: LG Electronics US A, 111 Sylvan Avenue, North Building, Englewood Cliffs, New Jersey 07632, United States Contact Phone Number: 201-470-2696 Email: [email protected] FRN: 0023476120 U.S. Agent Signature: _____________________ Signed by (Printed Name/Title): Heejae Cho/Team leader, LGEUS Regulatory and Environment Date: December 9, 2025
Date: To: Federal Communications Commission Authorization and Evaluation Division 7435 Oakland Mills Road Columbia, MD To whom it may concern: Subject : FCC Agent Authorization Letter for FCC ID :2BO3LLGSBTN65 This authorization is valid until further written notice from the applicant. Sincerely, Signed by: (Name) Yongdeok Kwon (Title) Professional [email protected] 82-31-8066-5538 (Address) December 9, 2025 222 LG-ro, Jinwi-myeon, Pyeongtaek-si, Gyeonggi-do 17709, South Korea We, the undersigned, hereby authorize HCT America, Inc. to act on our behalf in all manners relating to application for equipment authorization, including signing of all documents relating to these matters. Any and all acts carried out by HCT America, Inc. on our behalf shall have the same effect as acts of our own. We, the undersigned, hereby certify that we are not subject to a denial of federal benefits, that includes FCC benefits, pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. 853(a). We declare that the information provided to the FCC is true and correct to the best of our knowledge (47 CFR 2.911(d)) and we have been informed of the grantee responsibilities (47 CFR 2.909) with regard to certified equipment. ___________________________ (Email Address) (Phone number) We recognize that we are still responsible for the terms and conditions outlined in the HCT America Client Services Agreement.
Date: To: Federal Communications Commission Authorization and Evaluation Division 7435 Oakland Mills Road Columbia, MD SUBJECT: Request for Confidentiality for FCC ID:2BO3LLGSBTN65 We hereby request confidential treatment of the information accompanying this application as outlined below: Exhibit 1 2 3 4 5 6 7 8 Sincerely, Signed by: (Name) Yongdeok Kwon ( Title) Professional (Email Address) [email protected] (Phone number) 82-31-8066-5538 (Address) 222 LG-ro, Jinwi-myeon, Pyeongtaek-si, Gyeonggi-do 17709, South Korea December 9, 2025 Description Block Diagram Operational Description The above materials contain trade secrets and proprietary information not customarily released to the public. The public disclosure of these materials may be harmful to the applicant and provide unjustified benefits to its competitors. The applicant understands that pursuant to Section 0.457 & 0.459 of the Rules, disclosure of this application and all accompanying documentation will not be made before the date of the Grant for this application. LONG-TERM CONFIDENTIAL SHORT-TERM CONFIDENTIAL (180 DAYS) User’s Manual Test-Setup Photos Internal Photos External Photos Schematics Parts List LONG-TERM AND SHORT-TERM CONFIDENTIAL LIST
1761-4V1.2 X YYWW D LGSBTN65 2BO3LLGSBTN65 2703H-LGSBTN65 R-C-LGE-LGSBTN65 XXX-XXXXXX 3.2mm 3.2mm 40.0mm 27.0mm 36.0mm 23.0mm
TEST REPORT FCC MPE Test for LGSBTN65 Certification APPLICANT LG Electronics Inc. REPORT NO. HCT-RF-2512-FC003 DATE OF ISSUE December 8, 2025 Tested by Jin Gwan Lee Technical Manager Jong Seok Lee Accredited by KOLAS, Republic of KOREA F-TP22-03(Rev.06) 1 / 5 The report shall not be (partly) reproduced except in full without approval of the laboratory. HCT CO., LTD.2-6, 73, 74, Seoicheon-ro 578beon-gil, Majang-myeon, Icheon-si, Gyeonggi-do, Republic of Korea Tel. +82 31 645 6300 Fax. +82 31 645 6401 The report shall not be (partly) reproduced except in full without approval of the laboratory. F-TP22-03 (Rev. 06) Page 2 of 5 HCT CO.,LTD. 2-6, 73, 74, Seoicheon-ro 578beon-gil, Majang-myeon, Icheon-si, Gyeonggi-do, Republic of Korea Tel. +82 31 645 6300 Fax. +82 31 645 6401 TEST REPORT REPORT NO. HCT-RF-2512-FC003 DATE OF ISSUE December 08, 2025 A pplicantLG Electronics Inc. 222, LG-ro, Jinwi-myeon, Pyeongtaek-si, Gyeonggi-do 17709, Republic of Korea Product Name Model Name RF Module LGSBTN65 FCC ID2BO3LLGSBTN65 Date of TestNovember 10, 2025 ~ December 05, 2025 Frequency range2 402 MHz ~ 2 480 MHz (BT LE) Test Standard Used§1.1310, §2.1091 Test ResultsPASS Location of Test Ӎ Permanent Testing Lab ӎ On Site Testing Lab (Address: 74, Seoicheon-ro 578beon-gil, Majang-myeon, Icheon-si, Gyeonggi- do, Republic of Korea) Brand LG The report shall not be (partly) reproduced except in full without approval of the laboratory. Report No. HCT-RF-2512-FC003 F-TP22-03 (Rev. 06) Page 3 of 5 REVISION HISTORY The revision history for this test report is shown in table. Revision No. Date of Issue Description 0 December 08, 2025 Initial Release Notice Content Engineering Statement: The measurements shown in this report were made in accordance with the procedures indicated, and the emissions from this equipment were found to be within the limits applicable. I assume full responsibility for the accuracy and completeness of these measurements, and for the qualifications of all persons taking them. It is further stated that upon the basis of the measurements made, the equipment tested is capable of operation in accordance with the requirements of the FCC Rules under normal use and maintenance. The results shown in this test report only apply to the sample(s), as received, provided by the applicant, unless otherwise stated. The test results have only been applied with the test methods required by the standard(s). The laboratory is not accredited for the test results marked *. Information provided by the applicant is marked **. Test results provided by external providers are marked ***. When confirmation of authenticity of this test report is required, please contact www.hct.co.kr This test report provides test result(s) under the scope accredited by the Korea Laboratory Accreditation Scheme (KOLAS), which signed the ILAC-MRA. (KOLAS (KS Q ISO/IEC 17025) Accreditation No. KT197) The report shall not be (partly) reproduced except in full without approval of the laboratory. Report No. HCT-RF-2512-FC003 F-TP22-03 (Rev. 06) Page 4 of 5 RF Exposure Statement 1. Limit According to §1.1310, §2.1091 RF exposure is calculated. (B) Limits for General Population/Uncontrolled Exposures Frequency range (MHz) Electric field Strength (V/m) Magnetic field Strength (A/m) Power density (mW/cm²) Averaging time (minutes) 0.3 - 1.34 1.34 - 30 30 - 300 300 - 1500 1500 - 100.000 614 824/f 27.5 ... ... 1.63 2.19/f 0.073 ... ... (a) (100) (a) (180/ f²) 0.2 f/1500 1.0 30 30 30 30 30 F = frequency in MHz (a) = Plane-wave equivalent power density 2. Maximum Permissible Exposure Prediction Prediction of MPE limit at a given distance ଶ S = Power density P = Power input to antenna G = Power gain to the antenna in the direction of interest relative to an isotropic radiator R = Distance to the center of radiation of the antenna The report shall not be (partly) reproduced except in full without approval of the laboratory. Report No. HCT-RF-2512-FC003 F-TP22-03 (Rev. 06) Page 5 of 5 3. RESULTS 3-1. Bluetooth LE Average output Power at antenna input terminal 8.00 dBm Average output Power at antenna input terminal 6.31 mW Prediction distance 20.00 cm Prediction frequency 2402 ~ 2480 MHz Antenna Gain(typical) -0.480 dBi Antenna Gain(numeric) 0.895 - Power density at prediction frequency( S) 0.0011 mW/cm 2 MPE limit for uncontrolled exposure at prediction frequency 1.0000 mW/cm 2
TEST REPORT FCC BT LE Test for LGSBTN65 Certification APPLICANT LG Electronics Inc. REPORT NO. HCT-RF-2512-FC002 DATE OF ISSUE December 8, 2025 Tested by Jin Gwan Lee Technical Manager Jong Seok Lee Accredited by KOLAS, Republic of KOREA F-TP22-03(Rev.06) 1 / 40 The report shall not be (partly) reproduced except in full without approval of the laboratory. HCT CO., LTD.2-6, 73, 74, Seoicheon-ro 578beon-gil, Majang-myeon, Icheon-si, Gyeonggi-do, Republic of Korea Tel. +82 31 645 6300 Fax. +82 31 645 6401 The report shall not be (partly) reproduced except in full without approval of the laboratory. F-TP22-03 (Rev. 06) Page 2 of 40 HCT CO.,LTD. 2-6, 73, 74, Seoicheon-ro 578beon-gil, Majang-myeon, Icheon-si, Gyeonggi-do, Republic of Korea Tel. +82 31 645 6300 Fax. +82 31 645 6401 TEST REPORT REPORT NO. HCT-RF-2512-FC002 DATE OF ISSUE December 08, 2025 A pplicantLG Electronics Inc. 222, LG-ro, Jinwi-myeon, Pyeongtaek-si, Gyeonggi- do 17709, Republic of Korea Product Name Model Name RF Module LGSBTN65 FCC ID2BO3LLGSBTN65 Date of TestNovember 10, 2025 ~ December 05, 2025 FCC ClassificationDigital Transmission System(DTS) Test Standard UsedFCC Rule Part(s): Part 15.247 Test ResultsPASS Location of Test Ӎ Permanent Testing Lab ӎ On Site Testing Lab (Address: 74, Seoicheon-ro 578beon-gil, Majang-myeon, Icheon-si, Gyeonggi- do, Republic of Korea) Brand LG The report shall not be (partly) reproduced except in full without approval of the laboratory. Report No. HCT-RF-2512-FC002 F-TP22-03 (Rev. 06) Page 3 of 40 REVISION HISTORY The revision history for this test report is shown in table. Revision No. Date of Issue Description 0 December 08, 2025 Initial Release Notice Content Engineering Statement: The measurements shown in this report were made in accordance with the procedures indicated, and the emissions from this equipment were found to be within the limits applicable. I assume full responsibility for the accuracy and completeness of these measurements, and for the qualifications of all persons taking them. It is further stated that upon the basis of the measurements made, the equipment tested is capable of operation in accordance with the requirements of the FCC Rules under normal use and maintenance. The results shown in this test report only apply to the sample(s), as received, provided by th e applicant, unless otherwise stated. The test results have only been applied with the test methods required by the standard(s). The laboratory is not accredited for the test results marked *. Information provided by the applicant is marked **. Test results provided by external providers are marked ***. When confirmation of authenticity of this test report is required, please contact www.hct.co.kr This test report provides test result(s) under the scope accredited by the Korea Laboratory Accreditation Scheme (KOLAS), which signed the ILAC-MRA. (KOLAS (KS Q ISO/IEC 17025) Accreditation No. KT197) The report shall not be (partly) reproduced except in full without approval of the laboratory. Report No. HCT-RF-2512-FC002 F-TP22-03 (Rev. 06) Page 4 of 40 CONTENTS 1. EUT DESCRIPTION 5 2. TEST METHODOLOGY 6 EUT CONFIGURATION 6 EUT EXERCISE 6 GENERAL TEST PROCEDURES 6 DESCRIPTION OF TEST MODES 7 3. INSTRUMENT CALIBRATION 7 4. FACILITIES AND ACCREDITATIONS 7 FACILITIES 7 EQUIPMENT 7 5. ANTENNA REQUIREMENTS 8 6. MEASUREMENT UNCERTAINTY 8 7. DESCRIPTION OF TESTS 9 8. SUMMARY TEST OF RESULTS 25 9. TEST RESULT 26 9.1 DUTY CYCLE 26 9.2 6 dB BANDWIDTH 27 9.3 OUTPUT POWER 28 9.4 POWER SPECTRAL DENSITY 29 9.5 BAND EDGE/ CONDUCTED SPURIOUS EMISSIONS 30 9.6 RADIATED SPURIOUS EMISSIONS 32 9.7 RADIATED RESTRICTED BAND EDGES 35 9.8 POWERLINE CONDUCTED EMISSIONS 37 10. LIST OF TEST EQUIPMENT 38 11. ANNEX A_ TEST SETUP PHOTO 40 The report shall not be (partly) reproduced except in full without approval of the laboratory. Report No. HCT-RF-2512-FC002 F-TP22-03 (Rev. 06) Page 5 of 40 1. EUT DESCRIPTION Model LGSBTN65 Additional Model - EUT Type RF Module Power Supply DC 3.30 V Frequency Range 2 402 MHz ˊ 2 480 MHz Number of Channels 40 Channels Max. RF Output Power Peak 1 M Bit/s: 8.071 dBm (6.41 mW) Average 1 M Bit/s: 7.89 dBm (6.15 mW) Modulation Type GFSK Bluetooth Version 5.1 Antenna Specification Type: PIFA Antenna Peak Gain: -0.48 dBi Serial number Conducted : 25A0011A0000 Radiated : 25A0010B0000 Grant Notes : 1. Output Power listed is conducted(Peak) The report shall not be (partly) reproduced except in full without approval of the laboratory. Report No. HCT-RF-2512-FC002 F-TP22-03 (Rev. 06) Page 6 of 40 2. TEST METHODOLOGY Unlicensed wireless device were tested using the following measurement procedure. [1] KDB 558074 D01 15.247 Meas Guidance v05r02 [2] ANSI C63.10-2020 EUT CONFIGURATION The EUT configuration for testing is installed on RF field strength measurement to meet the Commissions requirement and operating in a manner that intends to maximize its emission characteristics in a continuous normal application. EUT EXERCISE The EUT was operated in the engineering mode to fix the Tx frequency that was for the purpose of the measurements. According to its specifications, the EUT must comply with the requirements of the Section 15.207, 15.209 and 15.247 under the FCC Rules Part 15 Subpart C. GENERAL TEST PROCEDURES Conducted Emissions The EUT is placed on the turntable, which is 0.8 m above ground plane. According to the requirements in Section 6.2 of ANSI C63.10-2020 Conducted emissions from the EUT measured in the frequency range between 0.15 MHz and 30 MHz using CISPR Quasi-peak and average detector modes. Radiated Emissions According to the requirements in Section 6.3 ~ Section 6.6 of ANSI C63.10-2020 The EUT is placed on a turn table, which is 0.8 m above ground plane below 1 GHz. Above 1 GHz with 1.5 m using absorbers between the EUT and receive antenna. The turntable shall rotate 360 degrees to determine the position of maximum emission level. EUT is set 3 m away from the receiving antenna, which varied from 1 m to …
Text truncated - open the document above for the full version.
LGSBTN65 Antenna Test Report Lab. 20251110 C O N T E N T S 1. Measurement Information 2. Antenna Characteristics 2.1 Return Loss 2.2 Antenna Efficiency and Peak Gain 2.3 3 views of antenna & 2D Radiation Patterns Measurement Information 1 Test ConditionTest EngineerTest EquipmentTest Date Radiated Yangda Lai GTS RayZone1800 KEYSIGHTE5071C 11.10.2025 Test information Measurement Information 1 Test Configuration Measurement Information 1 Reference Calibration Measurement Information 1 Reference Calibration Measurement Information 1 Test Software Measurement Information 1 Antenna Information overview ntennaCharacteristicsDetails Antenna Type & FormPIFA Antenna Antenna Gain (dBi)Refer to Antenna Specification Sheet DirectionalityOmnidirectional Antenna PolarizationNot applicable Connection Type to TransmitterInternal type Manufacturer & ModelBT ANT :Manufacturer:Hanyangmodel:F00100001008 Gain Measurement Institution GTS RayZone1800 KEYSIGHTE5071C Measurement Information 1 Ant. PositionAnt. TypeDimensions BTPIFA8*7.8*2.5mm Antenna Information overview BT Measurement Information 1 1.2 Antenna Solution Detail Antenna Information Measurement Information 1 1.2 Antenna Solution Detail Antenna Characteristics 2 2.1 Return Loss S11 Antenna Characteristics 2 2.2.1 Antenna Efficiency and Peak Gain BT Antenna Characteristics 2 2.2.2 Antenna Efficiency and Peak Gain Antenna Characteristics 2 2.3.1 3 views of antenna Antenna Characteristics 2 2.3.2 2D Radiation Patterns BT Thank you! D E S I G N E D B Y A I-L I N K
111 Sylvan Avenue, North Building · Englewood Cliffs, 07632 · United States
| # | Rule Parts | Frequency Range | Power Output |
|---|---|---|---|
| 1 | 15C | 2.40 GHz - 2.48 GHz | 6.00 mW |