<b>{{i18n "admin.logs.screened_ips.form.label"}}</b>
{{text-field value=ip_address disabled=formSubmitted class="ip-address-input" placeholderKey="admin.logs.screened_ips.form.ip_address" autocorrect="off" autocapitalize="off"}}

{{combo-box
  content=actionNames
  value=actionName
  onChange=(action (mut actionName))
}}

{{d-button class="btn-default" action=(action "submit") disabled=formSubmitted label="admin.logs.screened_ips.form.add"}}