Fillable Consumer Complaint Form (Page 2 of 2) in pdf

Consumer Complaint Form Page 2

Download a blank fillable Consumer Complaint Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Consumer Complaint Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

FR 1379c

YOUR INFORMATION

COMPLAINT

*Provide a brief description of the complaint including dates and the names of those you dealt with.

Do NOT include any personal information such as account numbers or Social Security numbers.

How can your complaint be satisfactorily addressed?

Privacy Act Statement

The information that you provide will permit the Federal Reserve to respond to consumer complaints and inquiries regarding practices by banks and other

nancial institutions supervised by the Board of Governors of the Federal Reserve System. The information may be disclosed:

• to a Federal Reserve-regulated entity that is the subject of a complaint or inquiry;

• to third parties to the extent necessary to obtain information that is relevant to the resolution of a complaint or inquiry;

• for enforcement, statutory, and regulatory purposes;

• to another agency or Federal Reserve Bank;

• to a member of Congress; to the Department of Justice, a court, an adjudicative body or administrative tribunal, or a party in litigation;

• to contractors, agents, and others; and

• where security or con dentiality has been compromised.

This collection of information is authorized by 12 U.S.C. §§ 248 and 1844, 15 U.S.C. § 57a(f ), and other consumer protection laws.

You are not required to le a complaint or inquiry and you may withdraw your complaint or inquiry at any time.

However, if you do so, the Federal Reserve may not be able to investigate your complaint or inquiry.

Paperwork Reduction Act Notice

This form is authorized by law (15 U.S.C. §57(a)(f )(1)) and is voluntary.

Public reporting burden for this information collection is estimated to average ten minutes per response. Send comments regarding this burden estimate

or any other aspect of this information collection, including suggestions for reducing this burden, to Secretary, Board of Governors of the Federal Reserve System,

20th and C Streets, N.W., Washington, DC 20551; and to the O ce of Management and Budget, Paperwork Reduction Project (7100-0181), Washington, DC 20503.

Signature:

Date:

Page 2 (9-16)

Consumer Complaint Form Page 2

Related Articles

Related forms

Related Categories