STATE OF CALIFORNIA – DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATIONCOMMENTS OR COMPLAINTS REGARDING DFPI PERFORMANCE
DFPI-803 (Rev. 06-21)(The Citizen Complaint Act of 1997, California Government Code Sections 8330-8332,
requires that all state agencies provide a method or form on the Internet through which
individuals can register complaints or comments relating to the performance of thatdepartment/agency.)
PLEASE NOTE: This form is for comments pertaining to the Department of Financial
Protection And Innovation (DFPI) performance only. Complaints or comments.
regarding DFPI licensees and financial services licensees should be filed throughthis link:
http://www.dfpi.ca.gov/file-a-complaint/
or by calling 1-866-275-2677.

The Department respectfully requests the information in this form to register andrespond to your comment or complaint about DFPI performance. Thank you for yourfeedback.
(Please print or type)
Last Name:First Name:
Address:
City:

State:

Zip:
Home Phone:()Business Phone:()

Email:Your prior contact with the DFPI was by (check all that apply):
Phone
Other (please specify)

In personIn writing

E-mailSTATE OF CALIFORNIA – DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATIONCOMMENTS OR COMPLAINTS REGARDING DFPI PERFORMANCE
DFPI-803 (Rev. 06-21) Page 2 of 3

Please describe your comment or complaint about the Department of Financial
Protection and Innovation in detail. Give the date, the name of the person, if
applicable, that was involved and any information (i.e., where, what, how) that will
help us respond to or resolve your comment or complaint.

Save Form
Please send your completed form to ombuds@dfpi.ca.gov or mail to:
California Department of Financial Protection and Innovation
2101 Arena Blvd.
Sacramento, CA 95834
ATTN: DFPI Ombudsman.
Once the comment or complaint is received, it will be reviewed and you may becontacted for further information.

STATE OF CALIFORNIA – DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATIONCOMMENTS OR COMPLAINTS REGARDING DFPI PERFORMANCE
DFPI-803 (Rev. 06-21) Page 3 of 3

DFPI’s Privacy Notice on Collection

DFPI Collects and Uses Personal Information: The DFPI collects the information
requested on this form as authorized by Government Code section 8330, et seq. The
DFPI uses this information to respond to comments pertaining to DFPI’s performance.
Use of the personal Information DFPI collects is subject to limitations contained in theInformation Practices Act of 1977 and other applicable state and federal laws.
Providing Personal Information Is Voluntary: You do not have to provide thepersonal information requested. If you do not want to provide personal information, suchas your name, home address or home telephone number, you may remain anonymous.
However, we may not be able to contact you or help resolve your issue.
DFPI May Disclose Your Personal Information: We may share your personalinformation with other state departments. Your personal information may also bedisclosed:•••

In response to a Public Records Act request, as allowed by the Information
Practices Act.
To another governmental agency as required by state or federal law.
In response to a court order or administrative order, a subpoena or a search
warrant.

Your Access to Your Personal Information: You may review the records
maintained by DFPI that contain your personal information. To request access,contact:
DFPI Privacy Officer
2101 Arena Blvd.
Sacramento, CA 95834(866) 275-2677