Fcc Form 475b - Federal Communications Commission Washington (Page 2 of 2) in pdf

You may submit this form over the Internet at

[web address to be inserted]

or by e- mail

to fccinfo@fcc.gov. Or you may mail this form and related information to: Federal

Communications Commission, Consumer & Governmental Affairs Bureau, 445 12

Street, SW, Washington, DC 20554.

You are not required to submit a transcript or an audiotape, videotape, CD/DVD or other

recording in support of your complaint. Doing so, however, may help expedite the

processing of your complaint. If you choose to submit a recording, you should send both

this complaint form and the recording to Federal Communications Commission,

Investigations & Hearings Division/Enforcement Bureau, 9300 East Hampton Drive,

Capital Heights, MD 20743. Any documentation of the programming becomes part of

the Commission’s records and cannot be returned.

For additional information, please see our Obscene, Profane, and Indecent Broadcasts

Fact Sheet at

FCC NOTICE REQUIRED BY THE PRIVACY ACT AND PAPERWORK REDUCTION ACT

The Federal Communications Commission is authorized under the Communications Act of 1934, as

amended, to collect the personal information that we request in this form. This form is used for complaints

about obscene, profane and indecent programming. The public reporting for this collection of information

is estimated to average 30 minutes per response, including the time for reviewing instructions, searching

existing data sources, gathering and maintaining the required data, and completing and reviewing the

collection of information. If you have any comments on this burden estimate, or how we can improve the

collection and reduce the burden it causes you, please write to the Federal Communications Commission,

AMD-PERM, Paperwork Reduction Project (3060-0874), Washington, DC 20554. We will also accept

your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet if you

send them to Leslie.Smith@fcc.gov. PLEASE DO NOT SEND YOUR COMPLETED FORMS TO THIS

ADDRESS.

Remember - You are not required to respond to a collection of information sponsored by the Federal

government, and the government may not conduct or sponsor this collection, unless it displays a currently

valid OMB control number or if we fail to provide you with this notice. This collection has been assigned

an OMB control number of 3060-0874.

THE FOREGOING NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW

93-579, DECEMBER 31, 1974, 5 U.S.C. SECTION 552a(e)(3) AND THE PAPERWORK

REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

Fcc Form 475b - Federal Communications Commission Washington Page 2