Alternative Dispute Resolution Form Requests, FCC Form 5628

OMB 3060-1258

This information, completed on FCC-5628, will be used by the OWD to process, track, and maintain the confidentiality of Alternative Dispute Resolution Intake Form requests.

The latest form for Alternative Dispute Resolution Form Requests, FCC Form 5628 expires 2021-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form Alternate Dispute Alternative Dispute Resolution Form Requests, FCC Form 5628 Form
OWD ADR SS_final version.docx Supporting Statement A
Alternative Dispute Resolution Form Requests, FCC Form 5628 Form

All Historical Document Collections

202107-3060-005 Approved without change	Extension without change of a currently approved collection	2021-07-20
201808-3060-002 Approved without change	New collection (Request for a new OMB Control Number)	2018-08-14