Federal Communications Commission - Slamming Complaint Form 501

Approved by OMB 3060-0968

Estimated Average Burden Per Respondent: 15 minutes

Federal Communications Commission
Slamming Complaint Form 501
For Slamming Complaints Only

This form uses JavaScript to validate your input. Please enable JavaScript processing in your browser.

In order for your Slamming complaint to be processed we need a copy of the phone bill(s) or a welcome letter/package, showing the name of the alleged unauthorized phone company and the disputed charges.

1. Complainant's Last Name:

2. Complainant's First Name: Middle Name:

3. If you are filing on behalf of a company or organization, please place its name here:

4. Complainant's Address or Company's Address:

4a. Street Address or Post Office Box Number:
4b. City:
4c. State:
4d. Zip Code:
4e. Your E-Mail Address:
4f. FAX Number: () -

5. Complainant's Daytime Telephone Number: () - Extension:

6. Are you filing this complaint on behalf of another party, such as a client or family member? Yes No

If yes, complete blocks 6a. through 6h.

6a. Your Relationship with the complainant:
6b. Your First Name: Middle Initial:
6c. Your Last Name:
6d. Your Daytime Telephone Number: () - Extension:
6e. Your Street Address or Post Office Box Number:

6f. Your City:
6g. Your State:
6h. Your Zip Code:

7. List all Telephone Numbers (Maximum of 6) -- including Area Codes, that you claim were slammed:

7a. () - 7b. () -

7c. () - 7d. () -

7e. () - 7f. () -

8. Which Type of Service is Involved with the Complaint?
Home (Residential) Telephone Service Business (Commercial) Telephone Service

9. Name(s) of unauthorized telephone company (local and/or long distance) that changed complainant's telephone service:
9a. 9b.

10. Name(s) of complainant's authorized telephone company(ies) (local and/or long distance) that service was changed from:
10a. 10b.

11 If this is a complaint about an unauthorized change in your long distance service provider, name of your local telephone company:

11a. Name of billing company, if different from local and/or long distance carrier(s):

12. Date complainant's telephone service was slammed (refer to bill, if available):
(MM/DD/YYYY)

If unknown, indicate date that the Complainant first became aware that his/her telephone service had changed:
(MM/DD/YYYY)

13. Have you contacted any company to try to resolve the complaint yourself?

Yes No

13a. If yes, name of company, name and number of company representative you spoke with:

13b. Date you spoke with company representative:
13c. If you contacted more than one company to resolve complaint, please list each company's name, date contacted, name and phone number of the person you spoke with:

13d. Are you back with your authorized carrier?

Yes No

13e. If yes, date changed back to authorized carrier (if known):
(MM/DD/YYYY)

14. Fill out blocks 14a through 14c if you are disputing charges listed on your telephone bill or your company's telephone bill.

14a. Amount of charges that is disputed:
14b. Have you paid any of the disputed charges? Yes No
14c. Did the billing company adjust or refund the disputed charges? Yes No
14d. If yes, what is the amount of the adjustment or refund?

15. What action(s) or resolution(s) do you want the companies to take or make in order to satisfy your complaint?

FCC Home

Federal Communications Commission
445 12th Street SW
Washington, DC 20554
More FCC Contact Information...

Phone:	1-888-CALL-FCC (1-888-225-5322)
TTY:	1-888-TELL-FCC (1-888-835-5322)
Fax:	1-866-418-0232
E-mail:	fccinfo@fcc.gov

- Web Policies & Privacy Statement
- Required Browser Plug-ins
- Customer Service Standards
- Freedom of Information Act

7a. () -	7b. () -
7c. () -	7d. () -
7e. () -	7f. () -