Product: phone
Not Yet Approved by OMB 3060-0874 (Estimated average burden per person is 15 minutes.)
Privacy Statement
Email address
Subject
Description of complaint
Phone issue
Unwanted calls/messages (telemarketing calls including do not call, prerecorded messages, advertising, mass texts, and spoofing)
My own number is being spoofed
All other unwanted calls/messages
Junk faxes
Availability
Coverage areas/coverage maps
Additional charge to make service available
Lifeline
No service available
Outside service area
Other (use description field)
Billing
Service charges (recurring charges, roaming, ETFs)
Lifeline
Taxes/fees/Surcharge (including Universal Service)
Advertised rates
Inmate calling
Other (use description field)
Cramming
Emergency Alert System
Missing audio attention signal
Missing vibration
Alerts received from other jurisdictions
Equipment
Device unlocking
Lifeline
Other (use description field)
Interference
Signal jammers
CB radio
Amateur radio
Broadcast AM/FM
Other (use description field)
Number portability
OI/Net Neutrality
Blocking
Data caps
Speed
Throttling
Inaccurate disclosures/Transparency
Other (use description field)
Privacy
Rural call completion
Service quality/repair
Slamming
Date of your issue/problem
Time of your issue/problem
Additional information you would like to share about this call or your interactions with this company
Telephone number where you received the unwanted call/message
Your phone type/location (residential/personal, business (including government and nonprofit organizations), patient room in health care or elderly care facility, Emergency phone line, toll free line)
Type of call/message (live person, prerecorded voice, text message)
Have you or anyone in your household or business given the caller/company permission to call? y/n/uncertain
Did the call/message that you are reporting advertise any type of goods, or services? y/n
If yes: type of property, goods, services
Have you or anyone else in your household done any business with the caller/company within the 18 months immediately before you received the call/message? y/n/uncertain
Have you or anyone else in your household made any inquiry or application to the caller/company within the 3 months immediately before you received the call/message? y/n/uncertain
Do you or anyone in your household have a personal relationship with the individual who made the call? y/n/uncertain
Did you receive caller ID information? y/n/uncertain/don’t have caller ID
If yes: caller ID number
Caller ID name
Was the caller’s business name provided DURING the call/message? Only provide information received during the call itself, NOT caller ID information. y/n/uncertain
If yes: business name
Was the business name provided at the beginning of the call?
Provide the name of the advertiser provided during the call
Provide the advertiser’s phone number given during the call
Fax advertiser transmission date
Type of property, goods, or services advertised
Copy of the fax provided (check box)
Have you or anyone else in your household or business given the fax advertiser permission to fax?
Have you or anyone else in your household or business done any business (including an
Inquiry application) with the fax advertiser?
Amount of charge
Reason for charge
Estimated time frame to complete
Name of Company responsible for unauthorized charge
Confirm copy of bill attached (check box)
Handset model
Additional company name
Has your personal information been accessed, obtained or used by an unauthorized person?
Describe what personal information has been accessed, obtained or used
Describe how you discovered your personal information had been accessed, obtained or used
Did you receive written notice from your provider about the data breach?
If yes, attach or describe the notice, include the date you received the notice and what it contained
Did you have previous security concerns about your provider?
If no: use description field to describe your issue
Telephone number called
Telephone number you are calling from
Date/time of call
Caller’s long-distance provider (not required)
Are you a service provider filing on behalf of a customer? Y/N
Confirm wireline phone (check box)
Confirm copy of bill attached (check box)
State for slamming
Residential or business phone
Local telephone provider
Long distance provider
Back with authorized provider? y/n
Disputed charges paid
Disputed charges adjusted/refunded
Amount of charges
Amount adjusted
Phone method
Telephone number subject of complaint
Company name
Are you a current, former, or prospective customer of this company?
Have you contacted this provider 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 |