<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}} {{d-button action="submit" disabled=formSubmitted label="admin.logs.screened_ips.form.add"}}