Approved by OMB 3060-0874 (Est. average burden per response is 15 minutes). Read Privacy Statement

If you would like to share your experience, please complete this form. In the description field, you can provide specific details about your experience , including the name of the provider, your address and any other information that describes the challenges that you have experienced, including those due to a provider’s practices and polices related to certain terms and conditions of service, such as those concerning speeds, data caps, throttling, late fees, equipment rentals and installation, contract renewal or termination, customer credit or account history, promotional rates, price or how technical support is provided.

By sharing their broadband access stories, consumers will help the FCC to identify barriers experienced by historically unserved and underserved communities and inform the work of the Task Force.

Fields marked with * are required. The submit button will not be active until all required fields are completed.

Web browsers supported: Latest two versions of: Chrome, Firefox, Safari, and Edge.

Your description is important to understanding your situation. Do not include any sensitive information, such as SSN, DOB, driver's license numbers, medical history, etc.

Scroll through the list to select the issue that best describes your complaint. If you have concerns about TV accessibility features (for example, closed captioning), please use the accessibility complaint form at

Select a sub issue that best describes your situation.

Select a sub issue that best describes your situation.

If yes, describe in the description field what personal information has been accessed, obtained or used and how you discovered it.

If yes, attach or describe the notice, include the date you received the notice and what it contained.

Examples of the time format are: 1:00 pm or 2:45 p.m. or 8:51 P.M.

You can click in the field to use a calendar to select a date. If you enter the date it must be in the following format: January 1, 2015

You must enter a specific name. Words like "all" or "every" will not be accepted.

Enter the tv channel such as 8 or 8.1

If you selected other, please provide the name of the subscription service.

You can find the call sign while watching TV by using the info button on your remote or the channel guide.. Examples of a call sign are: "WZUF" or "WZUE-TV."

Please select the company that is the subject of your complaint. If the company is not listed, select "other" and provide the name of the company.

If you selected other from the list of Company Names, please provide the company name here. Also, attach a recent bill/statement by selecting Attachments at the bottom of the form.

Please enter your account number, if applicable.

If you have a PO Box, please enter it in this field.

The format of the zip code can be: 20850 or 20850-1234

Please enter the phone number in the following format 555-555-5555

Please indicate whether you are filing this on behalf of someone else.

The format of the zip code can be: 20850 or 20850-1234

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