The ANA Privacy Shield Program Consumer Complaint Form

SECTION 1: Verification

To qualify for consideration under the EU-U.S. Privacy Shield Framework, complaints:

Must originate from consumers or businesses in one of the participating EU Member States. Please select which country it originates from:*

(If the nature of your complaint originates from the U.S., then please file a complaint here.)

Must involve a data privacy concern involving transfer of personally identifiable information (name, address, email address, phone, account information, etc.) from Europe to the United States. If it does not, this issue does not appear to be a data privacy complaint under the Privacy Shield Program. Please visit our Ethics Complaint page for additional ways to file ethics complaints with the ANA.

Does this complaint involve a data privacy concern involving transfer of personally identifiable information from Europe to the United States.*

Yes

SECTION 2: Authorization/Consent

Before filing your complaint with The ANA Privacy Shield Program, please note:

The ANA Privacy Shield Program is administered by the ANA. ANA is a U.S. trade association, and our handling of your complaint will require the processing of your personal data within the United States.

By completing and submitting the complaint form on the following pages you will authorize ANA staff to process your personal data provided by you or by the Participating Business about which you are complaining in accordance with the the ANA Complaint process. You will also authorize ANA to share that personal data with the Participating Business about which you are complaining, with the ANA Program Committee, and with technical experts, interpreters and translators and government regulators as needed, for purposes of resolving the complaint. ANA will handle your personal data in accordance with the ANA Privacy Policy.

I consent to the processing and sharing of my personal data under the terms stated above:*

Yes

The nature of the complaint must involve a participating ANA Privacy Shield Program member company. Staff will verify and inform you regarding membership status.

SECTION 3: Your Contact Information:

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

SECTION 4: Nature of your Complaint

Company/Organization name that you're bringing to our attention (required)*

Company Email

Company Website

Company contact person (if known)

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone Number (if known)

Please provide a brief overview of your concerns demonstrating lack of compliance with the Privacy Shield Principles (https://www.commerce.gov/privacyshield) such as not honoring your opt-out requests; concerns about sharing, use or protection of personal data; etc.

Please provide any supporting documentation here such as email correspondence; screen shots or other relevant materials that demonstrate lack of compliance with the Privacy Shield Principles

What resolution are you seeking?