FLORIDA DIGITAL BILL OF RIGHTS Use this complaint form to report a violation of Sections 501.701-501.722 (Florida Digital Bill of Rights) of the Florida Statutes.

Sections 501.701-722, Florida Statutes, requires certain companies to comply with authenticated requests from consumers to exercise specific rights related to consumers' online data. Such rights may include confirming whether the company is processing a consumer's personal data, correcting inaccuracies in a consumer's personal data, deleting any or all of a consumer's personal data, to obtain a copy of a consumer's personal data, allowing for the opting out of the processing of a consumer's personal data in regards to targeted advertising, the sale of personal data, and profiling, allowing for the opting out of the collection of a consumer's sensitive data, and allowing for the opting out of the collection of a consumer's personal data collected through the operation of a voice recognition or facial recognition feature.

Is your complaint about Sections 501.701-722, Florida Statutes, as outlined above?

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*Your Last Name:

*Your First Name:

*Home Address:

*City:

*State:

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*Zip Code:

*Home Telephone:

*Cellular Telephone:

*E-mail Address:

*Confirm E-mail Address:

*Username Associated with Account:

1.	*I am submitting this complaint on my own behalf.
	Yes No

	If you selected “No,” please provide below the information relating to the person on whose behalf you are filing this complaint. (If you selected “Yes,” please proceed to statement 2).
	*Last Name:
	*First Name:
	*Home Address:
	*City: *State: -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY *Zip Code:
	*Home Telephone: *Cellular Telephone:
	*Email Address:
	*Confirm Email Address:
	*Username Associated with Account:
	*Date of Birth:
	*What is your relationship with the person whose rights are the subject of this complaint? (Please select one)
	Person has authorized me to act for them in exercising their rights pursuant to section 501.705, Florida Statutes (if selected, please provide a written statement giving you authority to act for the person) Person granted authority to me to act for them under a power of attorney agreement I am the person’s parent or legal guardian Other (Please describe in detail your relationship in the space below)

2.	*Does this complaint involve a user under the age of 18?
	Yes No

3.	This complaint is filed against:
	*Name:
	*Website:
	*Address:
	*City: *State: -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY *Zip Code:
	*Telephone:
	If you desire to submit a complaint against more than one (1) business, please complete and submit a separate complaint for each business.

4.	*Please check all of the following actions you have requested from the business. (Please check all that apply to you or the person on whose behalf you are filing this complaint).
	To confirm whether the controller (business) is processing my personal data To correct inaccuracies in my personal data To delete any or all personal data provided by or obtained about me To obtain a copy of my personal data To opt out of the processing of my personal data for purposes of: Targeted advertising The sale of personal data Profiling To opt out of the collection of my sensitive data, including precise geolocation data, or the processing of sensitive data To opt out of the collection of personal data collected through the operation of a voice recognition or facial recognition feature Another right not listed above
	If you selected “Another right not listed above,” please describe in detail the right(s) you requested to exercise in the space provided below.
5.	*Did you previously submit a request to exercise your rights, or the rights of the person for whom you are submitting this complaint, to the business that is the subject of this complaint?
	Yes No Unknown
	If “No,” please skip to question 10.
	If “Yes,” please provide a copy of the request and answer questions 6 – 9 that follow.
6.	*Were you required to pay a fee regarding this request? If so, how much was the fee?
	Yes No Unknown
	Amount $:
7.	*Did you receive a response from the business regarding this request?
	Yes No Unknown
	If “Yes,” please provide a copy of this response from the business and any other communications/responses you received from the business?
8.	*If you received a response, did the business indicate it would not take any action?
	Yes No Unknown
9.	*If you made a request to the business and received a response, did you appeal or request that the business reconsider its decision?
	Yes No Unknown
	If “Yes,” please provide a copy of your communication and the response from the business.
10.	If you believe there is additional information concerning a potential violation of section 501.701, et seq, Florida Statutes, which you believe would assist the Office of the Attorney General in its investigation, please describe this information in detail below:

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Supporting documents should only include correspondence that you have had with the company that is the subject of your complaint. Please note, documents and attachments submitted to this agency are subject to public inspection pursuant to Chapter 119, Florida Statutes. Please do not include personal identifying information such as your driver’s license, social security number, or medical information here. If we need any additional information from you, we will make the relevant request. Upload 1 Upload 2 Upload 3 Upload 4

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Note:

1. All information submitted with this complaint is subject to public inspection pursuant to Chapter 119, Florida Statutes.
2. Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 837.06, Florida Statutes.

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