Form FCC Form 5642 FCC Form 5642 Private Entity Robocall and Spoofing Portal

Submit a request – FCC Private Entity Portal

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https://perportal.fcc.gov/hc/en-us/requests/new?ticket_form_id=67820...

FCC Private Entity Portal

Approved by OMB 3060-1296 (Est. average burden per response is 1 hour).
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FCC Private Entity Portal > Submit a request

Submit a request
Your email address

Subject

Call or Text Message Issue

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Entity Type

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Private Entity Name

Private Entity Street Address

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Submit a request – FCC Private Entity Portal

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https://perportal.fcc.gov/hc/en-us/requests/new?ticket_form_id=67820...

Private Entity City

Private Entity State

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Private Entity Zip Code

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

First Name of Private Entity Point of Contact

Last Name of Private Entity Point of Contact

Phone Number of Private Entity Point of Contact

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

Date of Relevant Call(s) or Text Message(s)

If reporting multiple calls then provide the date of the first call. If you have additional dates to report, please upload a file
as an attachment below.

Time of Relevant Call(s) or Text Message(s) (optional)

If reporting multiple calls then provide the time of the first call. Examples of the time format are: 1:00 pm or 2:45 p.m. or
8:51 P.M.

Time Zone (optional)

Did you receive caller ID information?

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Telephone Number(s) that Received the Call(s) at Issue

Enter the first telephone number. If you have additional numbers to report, please upload a csv file as an attachment
below.

Name of Private Entity’s Voice Service Provider for the Number(s) that Received the Call(s) or Text Message(s) at
Issue (optional)

Description

Provide any additional details about your robocalling and/or spoofing incident.

Attestation

I declare under penalty of perjury that (1) I am over 18 years old, (2) I am authorized to make decisions regarding the
telephone number listed below, and (3) the information I have provided today on this Federal Communications
Commission electronic form is, to the best of my knowledge, true and correct.

Attachments (optional)
Add file or drop files here

Submit

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Submit a request – FCC Private Entity Portal

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https://perportal.fcc.gov/hc/en-us/requests/new?ticket_form_id=67820...

Federal Communications Commission
45 L Street NE
Washington, DC 20554
Phone: 1-888-225-5322
ASL Video Call: 1-844-432-2275
Fax: 1-866-418-0232

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