Please do not include any sensitive personal information such as your social security number, driver license number, or financial account number on the form.
Fields with an asterisk (*) are required.
Notice on Collection of Personal Information
Collection and Use of Personal Information. The Department of Motor Vehicles, on behalf of the Investigations Unit, collects the information requested on this form as authorized by Vehicle Code 1655. The Department uses this information to follow up on your complaint.
Providing Personal Information Is Voluntary. You do not have to provide the personal information requested. If you do not wish to provide personal information, such as your name, home address, or home telephone number, you may remain anonymous. In that case, however, we may not be able to contact you or conduct further investigation into your complaint.
For more information, visit the Department of Motor Vehicle’s DMV and Your Information page.
