United States Election Assistance Comittee

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Note: If you wish to vote absentee and are a uniformed service member or family member or a citizen living outside the U.S., contact the Federal Voting Assistance Program to register to vote.

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Military and Overseas Voters

EAC has several projects under way to assist states in serving military and overseas citizens who register and vote absentee under the Uniformed and Overseas Citizens Absentee Voting Act. Learn more

Anomaly Reporting Form

OMB Control #3265-0004
Form EAC 003C


This form provides for the reporting of voting system anomalies by election officials. This form is part of the EAC Quality Monitoring Program. The use of this form is voluntary. Information regarding its use can be found in Section 8.7 of the Manual.

This form is self-explanatory.

Anomaly Reporting Form

indicates required field

A.  Election Official

1. Name, Title, Jurisdiction:
2. Phone Number:
3. Email:
4. Reported to Manufacturer?

B.  Product Description

5. Manufacturer Name:
6. Type of Voting System:
7. System Model:
8. Hardware & Software Versions:
9. Unit Serial Number:
10. EAC Certification Number:

C.  Description of Anomaly or Event

11. Date of Occurrence:
12. Polling Place Name or Locaction:
13. Election Type:
14. Was this your first election using this system?
15. Description of Anomaly:

This information is required for the EAC to provide for the certification of voting systems as required by 42 U.S.C. Section 15371. This information will be used solely to administer the EAC Testing and Certification Program. This program is voluntary, however, individuals who wish to participate must meet the requirements of the Program. This information will be made public consistent with the requirements of the Freedom of Information Act, the Trade Secrets Act, and any other applicable Federal law or regulation. Public reporting burden for this collection of information is estimated to average about 82 hours for completion of this form. This estimate includes the time for reviewing the instructions, gathering information and completing the form. Send comments regarding this burden estimate to the Testing and Certification Program Director, Election Assistance Commission, 1201 New York Avenue, NW, Suite 300, Washington, DC 20005. Not withstanding any other provision of law, no person is required to respond to, nor shall any person be subject to apenalty for failure to respond to, or comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.