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# Feedback form

- Documentation
- Questions or comments?

If you have difficulty with the following form, you can use any of our other service channels to contact us. Please read the Personal Information Collection Statement before completing this form.

Reason for contacting us (required)
Subject Message (required)

## Website Issues

Skip to Contact Information What page address (URL) or page description? What were you trying to do when you encountered the problem?
What were the problems?
small font that can't be adjusted
poor colour contrast
unclear information, typos or poor grammar
acronym or jargon not explained
confusing search results
poor keyboard navigation
some elements are too small to click on
images with no text alternative provided
multimedia without captions or text equivalent
moving or flashing object that can’t be controlled
incomplete or non-existent page (for example, “Page not found” error)
error notification is confusing or no error notification
other problem
How were you accessing the Web site today?

### Desktop & Laptop Information

Please include the version and other clarifying details Operating System Browser Adaptive or assistive device

### Mobile Information

Please include the version and other clarifying details Smartphone type Browser Adaptive or assistive device

## Follow-up

Please contact me if you require further details.
Send me a response.

### Contact Information

Please provide information that we could use to contact you Name E-mail address (required) Home phone number including area code (for example, 999-999-9999) Work phone number including area code (for example, 999-999-9999) Work phone number extension

## Personal Information Collection Statement

All personal information created, held or collected by this department is protected under the Privacy Act. This means that you will be informed of the purpose for which it is being collected and how to exercise your right of access to that information. You will be asked for your consent where appropriate.

### Public Communications

Provision of the information requested on this form is voluntary. The personal information you include in an inquiry may be used to prepare a reply. The personal information is collected pursuant to the [appropriate provision in department’s enabling statute]. Such information may be used for statistical, evaluation and reporting purposes. The information is included in the personal information bank [PIB Number - PIB Title]. The information may be shared with programs and activities of [Applied Title of the Department] should your inquiry pertain to a specific program or activity of the department. In such cases, the information is included in the personal information bank of the program or activity.

The transmission of this information is not secure so sensitive personal information, such as your Social Insurance Number, should not be included in your message.

If after reading this statement, you prefer not to submit your inquiry via the Internet, you may use one of the following methods:

### Privacy inquiry

Any questions, comments, concerns or complaints regarding the administration of the Privacy Act and privacy policies may be directed to the departmental Privacy Coordinator by email to [Privacy Coordinator email], by calling [Privacy Coordinator phone number] or writing to:

[Privacy Coordinator mailing address]

If you are not satisfied with our response to your privacy concern, you may wish to contact the Office of the Privacy Commissioner by e-mail at info@priv.gc.ca or by telephone at 1-800-282-1376.

Date modified:
  2013-04-11