Open Government Services
Complaint Form

Government Agency

Type of government agency with whom you have had difficulty.

Federal State
County Municipal
Cross-judisdictional and across state lines, such as the New York - New Jersy Port Authority.
Cross-jurisdictional within one state, such the Southern California Regional Rail Authority.
Not sure

Agency Address

Agency Name:
Street Address:
Building number:
Floor number:
Room number:
City:
State:
Zip code:
If your encounter happened at any other location, describe the location:

If any other agencies were involved, describe them here, with their contact info:
 


Public Records

Were you denied access to public records?

Yes No

 
If so, describe the records you requested:

How did you make your request for these records?

When did you make your request for these records?

To whom did you make your request for these records? If you do not have names, a description of the people, if it occurred in person, the exact date if you can remember it, what time of day it was, where they were stationed, etc., would be helpful.


Civil Rights

Were your civil rights violated?

Yes No

 
Describe how:

 
Describe when:

 
Describe whom: If you do not have a name, a description of the people, if it occurred in person, the exact date if you can remember it,what time of day it was, where they were stationed, etc., would be helpful.


Conclusion

Is there anything else about your case you wish to say?




Privacy Notice: We do not share our contact information with anyone. You will not be put on any mailing lists.

Would you like to make this complaint anonymously?

Yes No

Name:
Mailing address:
City:
State:
Zip code:
Email address:
Reenter email address:
Phone(s);
 Daytime:
 Evening:



Please check your inputs, the more accurate and complete your information the sooner we will be able to process your complaint.



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Revised: Fri, Aug 8th, 2003, 5:13 pm EDT
 
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