Form FCC Form 5642 FCC Form 5642 Private Entity Robocall and Spoofing Portal

OMB Control No. 3060-XXXX FCC Form 5642 Estimated time per response 60 minutes (1 hour)

Private Entity Robocall and Spoofing Portal

We have estimated that your response to this collection of information will take an average of 60 minutes (1 hour). Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, Office of Managing Director, AMD PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060- XXXX). We will also accept your PRA comments via the Internet if you send an e-mail to [email protected].

Please DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. 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 and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-XXXX.

THIS NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

Privacy Statement

Subject

Call or Text Message Issue

Robocalling (47 U.S.C. § 227(b))

Spoofing (47 U.S.C. § 227(e))

Robocalling and Spoofing

Other

Describe Issue

Private Entity Name

Street Address

City

State

Zip Code

First Name of Private Entity Point of Contact

Last Name of Private Entity Point of Contact

Phone Number of Private Entity Point of Contact

Email of Private Entity Point of Contact

Time of Relevant Call(s) or Text Message(s)

Date of Relevant Call(s) or Text Message(s)

Caller ID Displayed

Telephone Number(s) that Received the Call(s) at Issue

Name of Private Entity’s Voice Service Provider for the Number(s) that Received the Call(s) or Text Message(s) at Issue

Description of Issue (this may include content of call(s)/message(s))

Attestation

Attachments (optional)

[Month] 2021