TRS Consent

As required by the Federal Communications Commission (“FCC”), I acknowledge that ClearCaptions will collect the following personally-identifiable information from me:

• My full legal name
• My residential address (and my registered location/911 address, if different)
• My telephone number
• The last four digits of my Social Security Number
• My date of birth
• A copy of my self-certification of eligibility for IP CTS and the date it was obtained by ClearCaptions

In accordance with FCC requirements, I acknowledge that the information I am providing will be submitted to the FCC’s Telecommunications Relay Service User Registration Database (“TRS-URD”), which is managed by the FCC’s TRS Fund Administrator, to ensure proper administration of the TRS program.

I acknowledge that I will be denied service if I do not consent to submitting the above information to the TRS-URD.

By signing this form, I am consenting to allow ClearCaptions to collect and share my personally-identifiable information with the TRS-URD.