Test Library

Complaint Intake Form

Note: Fields marked with an * are required.

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Respondent Name (Member of Congress) *

Date Communication Was Received *

Complaint One Type *

Complaint One Summary * Please describe your complaint in greater detail, providing as much information as possible for our review.

If you have multiple violations please add them separately here. If more than three, please specify in the last notes section and a staffer will reach out to collect alleged complaints.

Complaint Two Type

Complaint Two Summary Please describe your complaint in greater detail, providing as much information as possible for our review.

Complaint Three Type

Complaint Three Summary Please describe your complaint in greater detail, providing as much information as possible for our review.

Attach Evidence (Max size 20mb) Accepted formats .png, .jpg, .jpeg, .txt, .doc, .docx, .pdf, .zip

Check the box below to acknowledge this statement: *

I hereby verify that I have read the above complaint procedures and the contents thereof. I also verify that, to the best of my knowledge, the matters stated in the complaint are true and correct. I understand that the Commission may dismiss the complaint without further inquiry if the complaint does not identify a violation of a specific law, rule or regulation on a good faith basis, or if the complaint is not accompanied by relevant and material evidence in a format accessible to the Commission (e.g. .pdf, .doc, .jpg, etc.). I understand that my first name, last name, city, and state of residence will be made public upon submission of materials.

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