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Complaint Form

The document is an Informal Complaint Form from the Federal Communications Commission (FCC) for consumers to report issues related to TV, phone, internet, radio, and accessibility. It provides contact information, instructions for submitting complaints, and details about the Privacy Act and Paperwork Reduction Act. Consumers can file complaints electronically or by fax and are encouraged to provide relevant details about their issues.

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Kalyan Krishna Gali
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33 views

Complaint Form

The document is an Informal Complaint Form from the Federal Communications Commission (FCC) for consumers to report issues related to TV, phone, internet, radio, and accessibility. It provides contact information, instructions for submitting complaints, and details about the Privacy Act and Paperwork Reduction Act. Consumers can file complaints electronically or by fax and are encouraged to provide relevant details about their issues.

Uploaded by

Kalyan Krishna Gali
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Informal Complaint Form

Federal Communications Commission


Consumer & Governmental Affairs Bureau
Phone: 1-888-CALL-FCC (1-888-225-5322)
Fax: 1-866-418-0232
TTY: 1-888-TELL-FCC (1-888-835-5322)
American Sign Language Support Line: 1-844-4-FCC-ASL (1-844-432-2275)

For faster submission, consider filing your complaint electronically at


www.fcc.gov/complaints

CONTACT INFORMATION
(Colons below designate locations for responses)

First Name:

Last Name:

Company Name (if applicable):

Street Address/ PO Box:

City or Town:

State:

Zip Code:
Telephone Number and extension (if applicable):

Best Time to Contact You if Additional Information is Needed:

E-mail Address:

COMPLAINT INFORMATION
Your Issue (choose all that apply by placing an “X” on same line):

TV

Availability:
Billing:
Equipment:
Indecent Content:
Loud Commercials:

Phone

Unwanted Calls:
Availability:
Billing:
Cramming:
Equipment:
Interference:
Junk Faxes:
Number Portability:
Rural Call Completion:
Slamming:

Internet

Availability:
Billing:
Equipment:
Interference:
Speed:

Radio

Availability:
Billing:
Equipment:
Indecency:
Interference:
Pirate Radio:

Access for People with Disabilities

Closed Captioning:
Emergency Information:
Hearing Aid Compatibility:
Telecommunications Relay Service:
Video Description:

Emergency Communications

Interference:
Phone/911:
Tower Light Outage:

Identify the name of the company that you are complaining about:

Describe what happened so that we can understand your issue. If


relevant, include the name of the company you are complaining about,
your account number and any other information you think might be
pertinent. You may attach any documents you believe will support your
complaint:

Privacy Act Statement

The Privacy Act is a law that requires the Federal Communications


Commission (FCC) to explain why we are asking you for personal information
and what we are going to do with this information after we collect it.

Authority: The FCC is authorized under the Communications Act of 1934, as


amended, to collect the personal information that is requested through the
Consumer Complaint Center (CCC). The FCC is authorized to request this
information from consumers under 47 U.S.C. 151, 154, 206, 208, 225, 226,
227, 228, 255, 258, 301, 303, 309(e), 312, 362, 364, 386, 507, 610, 613, 617,
618, and 619; Section 504 of the Rehabilitation Act, 29 U.S.C. 794 and 794d;
and 47 CFR 0.111, 0.141, 1.711 et seq., 14.30 et seq., 20.19, 64.604, 68.414 et
seq., and 79.1 et seq..

Purpose: We are collecting this information so that we can process informal


consumer complaints, inquiries, and requests for dispute assistance from
individuals, groups, and other entities. We access, maintain and use the
information that you provide in the CCC as described in the system of records
notice (SORN), FCC/CGB-1, available at https://www.fcc.gov/managing-
director/privacy-transparency/privacy-act-information#systems.

Routine Uses: We may share the personal information you enter into the CCC
with other parties for specific purposes, such as:

 with the provider/company the complaint is filed against to get a


response for you;
 in an FCC enforcement action, your name may be made public unless
you explicitly request confidentiality;
 with other state/local or federal agencies for investigation,
enforcement, or prosecution by another agency;
 with a congressional office in response to an inquiry;
 with the public after redaction of personal information;
 with other agencies or organizations in response to a breach of
information.
FCC Notice Required by the Paperwork Reduction Act

The Federal Communications Commission is authorized under the


Communications Act of 1934, as amended, to collect the personal information
that we request through the Consumer Complaint Center (CCC). The CCC is
used for complaints that involve: (1) phone, (2) TV, (3) radio; (4) emergency,
(5) Internet (6) accessibility, and (7) general inquiries/comments. The public
reporting for this collection of information is estimated to average 15 minutes
per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the required data, and completing
and reviewing the collection of information. The CCC is also used for
Accessibility/Requests for Dispute Assistance. The public reporting for this
collection of information is estimated to average 30 minutes per response,
including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the required data, and completing and reviewing
the collection of information. If you have any comments on these burden
estimates, or how we can improve the collection and reduce the burden it
causes you, please write to the Federal Communications Commission, OMD-
PERM, Paperwork Reduction Project (3060-0874), Washington, DC 20554. We
will also accept your comments regarding the Paperwork Reduction Act
aspects of this collection via the Internet if you send them to PRA@fcc.gov.

Remember - You are not required to respond to a collection of information


sponsored by the Federal government, and the government may not conduct
or sponsor this collection, unless it displays a currently valid OMB control
number or if we fail to provide you with this notice. This collection has been
assigned an OMB control number of 3060-0874.

THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION


ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. 3507.
How to Submit Your Informal Complaint
You may submit this form by fax to 1-866-418-0232, or by postal mail to:

Federal Communications Commission


Consumer & Governmental Affairs Bureau
Consumer Inquiries and Complaints Division
45 L Street, NE
Washington, D.C. 20554.

In addition, you may submit your complaint or obtain consumer information


over the telephone by calling 888-CALL-FCC (1-888-225-5322) voice, or 1-
888-TELL-FCC (1-888-835-5322) TTY, or 844-4-FCC-ASL (1-844-432-2275)
ASL. An FCC customer service representative will fill out an electronic version
of the form for you during your conversation.

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