discourse/app/assets/javascripts/admin/addon/templates/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}} @class="ip-address-input" @placeholderKey="admin.logs.screened_ips.form.ip_address" @autocorrect="off" @autocapitalize="off" />
<ComboBox @content={{this.actionNames}} @value={{this.actionName}} @onChange={{action (mut this.actionName)}} />
<DButton @class="btn-default" @action={{action "submit"}} @disabled={{this.formSubmitted}} @label="admin.logs.screened_ips.form.add" />