Category: Internet Organizations
Not Yet Approved by OMB 3060-0874 (Estimated average burden per person is 15 minutes.)
Privacy Statement
Email address
Subject
Description
Does your complaint involve digital discrimination of access based on income level, race, ethnicity, color, religion, or national origin? Y/n/Don't know
If yes:
Which of the following characteristics is your digital discrimination of access complaint based on? (Multi-select)
income level
race
ethnicity
color
religion
national origin
none of the above
Do other members of your neighborhood or area also experience the issue described in your complaint? Y/n/Don't know
If yes:
Is the issue affecting 500 or more households? Y/n/Don't Know
City of Location
State of Location
Zip of Location
Is there a neighboring area that is receiving better service than you? Y/n/Don't Know
If yes:
Name of the neighboring area
City of the neighboring area
State of the neighboring area
Zip of the neighboring area
Name of Internet Service Provider(s) Involved
Name of your Organization
Your First Name
Your Last Name
City
State
Zip Code
Contact Phone Number
Attestation (Check Box)
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 | 2024-07-22 |