Product: Request for Dispute Assistance (Accessibility)
Approved by OMB 3060-0874 (Estimated average burden per person is 30 minutes.)
Email address
Subject
Type of service or equipment that best describes your accessibility problem
Wireless or mobile telephone service or equipment
Wireline or landline telephone service or equipment
Cable or Internet telephone service or equipment
Internet voice communication service or equipment
Electronic messaging service or equipment
Interoperable video conferencing service or equipment
Internet browser built into a wireless or mobile telephone
Preferred method of response
Equipment manufacturer name
Type of device
Model number of device
Name of service provider
Name of the software or application
Version of the software or application
Name of the Internet browser
Version of the internet browser
Date of service or equipment
Date of accessibility problem
Description of service or equipment
Contacting the company about the accessibility problem
Outcome of accessibility problem
First name
Last name
City
State
Zip code
Phone (where you can be contacted)
Type of Telephone number
Filing on behalf of someone (y/n)
If yes, your relationship (on behalf of)
First name (on behalf of)
Last name (on behalf of)
Company name (on behalf of)
Address (on behalf of)
City (on behalf of)
State (on behalf of)
Zip code (on behalf of)
Description
Can the FCC share your description of your complaint (minus PII) with the public on our website? y/n
Attachments
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Kimberly Wild |
| File Modified | 0000-00-00 |
| File Created | 2021-08-30 |