discourse/app/assets/javascripts/admin/addon/components/screened-ip-address-form.hbs

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<label>{{i18n "admin.logs.screened_ips.form.label"}}</label>
<TextField
@value={{this.ip_address}}
@disabled={{this.formSubmitted}}
@placeholderKey="admin.logs.screened_ips.form.ip_address"
@autocorrect="off"
@autocapitalize="off"
class="ip-address-input"
/>
<ComboBox
@content={{this.actionNames}}
@value={{this.actionName}}
@onChange={{fn (mut this.actionName)}}
/>
<DButton
@action={{this.submitForm}}
@disabled={{this.formSubmitted}}
@label="admin.logs.screened_ips.form.add"
type="submit"
class="btn-default"
/>