Product: TV
Not Yet Approved by OMB 3060-0874 (Estimated average burden per person is 15 minutes.)
Privacy Statement
Email address
Subject
Description
TV issue
Availability
Billing
Emergency Alert System
Equipment
Set top boxes
Cable cards
Other (use description field)
Indecency
Interference
From CB
From amateur radio
Other (use description field)
Loud commercials
How did you access and watch the video programming and commercial?
Cable
Satellite
Over the Air
Streaming
Name of your Provider
Other (use description field)
Time of your issue/problem
Date of your issue/problem
TV channel
Call sign (If Over the air)
Name of the commercial’s advertiser/sponsor and/or product involved
Network
Name of TV program
Name of Streaming App/Service
Other (use description field)
City where program was viewed/heard
State where the program was viewed/heard
Company name
Relationship to Company
Have you contacted the Company about this issue? y/n
Account number
First name
Last name
Address
City
State
Zip code
Phone (where you can be contacted)
Filing on behalf of someone
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)
Age of Complaint Filer
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Race - Select one or more:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Primary language spoken at home - Select one or more:
English
Spanish
Chinese
French
Tagalog
Vietnamese
German
Korean
Other
Total Household Income
0-$20,000
$20,001-60,000
$60,001 - $100,000
$100,001 - $150,000
$150,001+
Housing
Multi-Unit Building (Apartment or Condo)
Single Family Home (House, Mobile Home, Townhome)
Other
Attestation
Can the FCC share your description (minus PII) of your complaint 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 | 2024-07-22 |