Category: Accessibility
Not Yet Approved by OMB 3060-0874 (Estimated average burden per person is 15 minutes.)
Privacy Statement
Email address
Subject
Description
Accessibility issues
Closed Captioning on TV
Closed Captioning over the Internet
Display of Closed Captioning
Emergency Information on TV
Hearing Aid Compatibility of Wireless Phones
Hearing Aid Compatibility of Wireline Phones
National Deaf-Blind Equipment Distribution Program
Real-Time Text (RTT)
TRS
TV and Set-top Box Controls, Menus, and Program Guides
Video Description
Preferred method of response
Name of company complaining about
City of company complaining about
State of company complaining about
Zip code of company complaining about
Phone number of company complaining about
Name of state program complaining about
Please provide the model of the telephone
Hearing aid compatibility make
Date of your issue/problem
Time of your issue/problem
Your TV method
Name of subscription service
Contact the company (y/n)
Name of company and person contacted
Date contacted
TV channel
Call sign
Network
Name of TV program
City where program was viewed/heard
State where program was viewed/heard
Program distributor/owner
Device or software used
Your First name
Your Last name
Address 1
Address 2
City
State
Zip code
Phone (where you can be contacted)
Filing on behalf of someone (y/n)
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 | 2024-09-24 |