Suggestions / Concerns

Name

Your Email Address

Your phone#

Date of Incident

Address of Incident

State

Zip Code

Name of establishment (if applicable)

Description of the problem/issue (please be as specific as possible as to the timing and recurrence of the problem if applicable)

If you have contacted 311, please provide the Service Request #

If you have contacted the party responsible for the incident, please provide the outcome

If you have contacted other agencies about this issue, please list the agency and/or complaint number (e.g. NYPD, DOB, Sanitation):