Approved by OMB 3060-0874 (Est. average burden per response is 15 minutes).
Fields marked with * are required. The submit button will not be active until all required fields are completed.
Please provide the details of your issue. Do not enter personal information like name, address, phone or account number. There are places to enter that information below, if applicable.
Select a sub issue that best describes your situation.
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
Examples of the time format are: 1:00 pm or 2:45 p.m. or 8:51 P.M.
Please provide the name of the radio company.
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.