DocDraft Logo

Fair Credit Billing Act Dispute Form: Your Guide to Resolving Billing Errors

Learn how to use the Fair Credit Billing Act Dispute Form to challenge credit card billing errors, incorrect utility charges, and disputed medical bills. Protect your consumer rights with our step-by-step guide.

Introduction

The Fair Credit Billing Act (FCBA) Dispute Form is a powerful consumer protection tool that allows you to formally challenge billing errors on your credit card statements, utility bills, and medical invoices. Created under federal law, this form gives you the legal right to dispute charges you believe are incorrect, unauthorized, or unfair. By submitting this form to your creditor, you initiate a formal investigation process that requires the company to respond within specific timeframes. During this investigation period, you cannot be penalized for withholding payment on the disputed amount, and the creditor cannot report you as delinquent to credit bureaus. Whether you've been double-charged on your credit card, billed for utility services you never received, or faced questionable medical charges, the FCBA Dispute Form helps level the playing field between you and large billing entities.

Key Things to Know

  1. 1

    You must submit your dispute within 60 days of the first bill containing the error—not from when you discovered the error.

  2. 2

    Always send dispute forms via certified mail with return receipt requested and keep copies of all correspondence.

  3. 3

    You can withhold payment on the disputed portion of your bill during the investigation, but you must pay any undisputed amounts.

  4. 4

    Creditors must acknowledge your dispute within 30 days and resolve it within two billing cycles (maximum 90 days).

  5. 5

    If you're disputing a credit card charge for goods or services, it's often helpful to also contact the merchant directly to try resolving the issue.

  6. 6

    For medical billing disputes, request an itemized bill and explanation of benefits (EOB) from your insurance to help identify specific errors.

  7. 7

    Utility billing disputes may also be addressed through your state's public utility commission if the company is unresponsive.

  8. 8

    If your creditor violates FCBA procedures, they may forfeit the right to collect up to $50 of the disputed amount, even if the charge was correct.

Key Decisions

Consumers with Medical Bills

Utility Service Customers

Credit Card Account Holders

Customize your Fair Credit Billing Act Dispute Form Template with DocDraft

FAIR CREDIT BILLING ACT DISPUTE FORM

PERSONAL INFORMATION

Full Legal Name: [FULL LEGAL NAME]
Account Number: [ACCOUNT NUMBER]
Billing Address:
[STREET ADDRESS]
[CITY, STATE ZIP CODE]
Phone Number: [PHONE NUMBER]
Email Address: [EMAIL ADDRESS]

CREDITOR INFORMATION

Creditor Name: [CREDITOR NAME]
Billing Dispute Address:
[CREDITOR BILLING DISPUTE ADDRESS]
[CITY, STATE ZIP CODE]

DISPUTE DETAILS

Merchant Name: [MERCHANT NAME]
Transaction Date: [TRANSACTION DATE]
Transaction Amount: $[AMOUNT]
Billing Statement Date: [BILLING STATEMENT DATE]

DISPUTE CATEGORY

(Please check the appropriate category)

  • Unauthorized charge - I did not authorize this transaction
  • Duplicate charge - I was charged twice for the same transaction
  • Incorrect amount - The amount charged differs from my receipt/agreement
  • Goods/services not received - I paid but did not receive the merchandise/service
  • Goods/services not as described - The item/service received was defective, damaged, or not as described
  • Cancelled recurring payment - I cancelled this recurring payment on [DATE]
  • Credit not processed - The merchant agreed to issue a credit that has not appeared
  • Paid by other means - I paid for this transaction using another method
  • Other (please specify): _______________________________________________

DETAILED DESCRIPTION OF DISPUTE

I am writing to dispute a billing error on my account pursuant to my rights under the Fair Credit Billing Act (15 U.S.C. § 1666). The specific details of my dispute are as follows:

[PROVIDE DETAILED DESCRIPTION OF THE DISPUTE, INCLUDING RELEVANT DATES, COMMUNICATIONS WITH THE MERCHANT, AND ANY OTHER PERTINENT INFORMATION THAT SUPPORTS YOUR CLAIM]

PREVIOUS ATTEMPTS TO RESOLVE

I have made the following attempts to resolve this matter directly with the merchant:

  1. Date of contact: [DATE]
    Method of contact: [PHONE/EMAIL/IN PERSON]
    Person contacted: [NAME/POSITION]
    Outcome: [DESCRIBE OUTCOME]

  2. Date of contact: [DATE]
    Method of contact: [PHONE/EMAIL/IN PERSON]
    Person contacted: [NAME/POSITION]
    Outcome: [DESCRIBE OUTCOME]

LEGAL NOTICES AND REQUESTS

  1. Timely Notification: I hereby certify that I am submitting this dispute within 60 days of the first billing statement on which the error appeared, as required by the Fair Credit Billing Act.

  2. Written Notification Statement: This letter serves as written notification of a billing error under the Fair Credit Billing Act (15 U.S.C. § 1666).

  3. Request for Investigation: I formally request that you investigate this disputed charge as required under the Fair Credit Billing Act and provide me with a written explanation of your findings.

  4. Request for Documentation: Please provide copies of any documentation supporting the disputed charge, including but not limited to sales slips, invoices, delivery confirmations, or other relevant records.

  5. Withholding Payment: In accordance with my rights under the Fair Credit Billing Act, I am withholding payment on the disputed amount while this investigation is pending. I understand that I remain obligated to pay any undisputed portions of my bill.

  6. Credit Reporting Protection: I request that you not report the disputed amount as delinquent to any credit reporting agencies during the investigation period, as required by the Fair Credit Billing Act.

  7. Response Timeframe: I understand that under the Fair Credit Billing Act, you must acknowledge receipt of this dispute within 30 days of receiving it, and you must resolve this dispute within two billing cycles (not to exceed 90 days) after receiving this notice.

SUPPORTING DOCUMENTATION

I have attached the following documentation to support my dispute:

  • Copy of the billing statement showing the disputed charge
  • Proof of payment (if applicable)
  • Copies of communications with the merchant regarding this dispute
  • Product/service documentation showing defects or failure to deliver as promised
  • Other relevant documentation: _______________________________________________

CERTIFICATION AND SIGNATURE

I hereby certify that the information provided in this dispute form is true and accurate to the best of my knowledge. I understand that making false statements on this form may constitute fraud.

Signature: _______________________________________________

Date: _______________________________________________

DELIVERY INFORMATION

This dispute form should be sent to the creditor's billing dispute address listed above via certified mail with return receipt requested to document delivery. The certified mail tracking number is: [TRACKING NUMBER]

RECORD KEEPING INSTRUCTIONS

Please keep copies of all dispute documentation, including:

  • This completed dispute form
  • All supporting documentation submitted with this form
  • Certified mail receipt and return receipt
  • Any correspondence received from the creditor regarding this dispute
  • Notes from any phone conversations regarding this dispute, including date, time, and the name of the representative

FOLLOW-UP INFORMATION

If you do not receive acknowledgment of this dispute within 30 days, or if the dispute is not resolved within 90 days, you may wish to:

  1. Contact the creditor's customer service department for a status update
  2. File a complaint with the Consumer Financial Protection Bureau (CFPB) at www.consumerfinance.gov
  3. File a complaint with the Federal Trade Commission (FTC) at www.ftc.gov
  4. Consult with a consumer rights attorney regarding additional legal remedies

IMPORTANT NOTICE: This form is provided as a template to assist consumers in exercising their rights under the Fair Credit Billing Act. The information contained herein does not constitute legal advice. For specific legal guidance regarding your particular situation, please consult with a qualified attorney.

Missouri Requirements for Fair Credit Billing Act Dispute Form

15 U.S.C. § 1666 - Correction of Billing Errors (15 U.S.C. § 1666)

Establishes the consumer's right to dispute billing errors and requires creditors to acknowledge disputes within 30 days and resolve them within 90 days. During investigation, consumers cannot be charged interest or penalties on disputed amounts.

15 U.S.C. § 1666a - Regulation of Credit Reports (15 U.S.C. § 1666a)

Prohibits creditors from reporting disputed amounts as delinquent to credit bureaus while the dispute is under investigation. Creditors must also report the resolution of disputes to credit bureaus.

15 U.S.C. § 1666i-1 - Limits on Interest Rate Increases (15 U.S.C. § 1666i-1)

Restricts creditors from increasing interest rates on existing balances except under specific circumstances, providing protection during billing disputes.

12 C.F.R. § 1026.13 - Regulation Z Billing Error Resolution (12 C.F.R. § 1026.13)

Implements the FCBA's billing error resolution procedures, defining what constitutes a billing error and establishing the timeline and process for resolving disputes.

Missouri Merchandising Practices Act (Mo. Rev. Stat. § 407.010 et seq.)

Prohibits deception, fraud, and unfair practices in consumer transactions, providing additional state-level protection for Missouri consumers in billing disputes.

Missouri Credit Services Organizations Act (Mo. Rev. Stat. § 407.635-407.644)

Regulates organizations that provide credit services to Missouri consumers, including those that might assist with credit billing disputes.

Missouri Statute of Limitations on Written Contracts (Mo. Rev. Stat. § 516.110)

Sets a 10-year limitation period for actions on written contracts in Missouri, which may affect the timeframe for disputing certain billing errors.

Missouri Electronic Transactions Act (Mo. Rev. Stat. § 432.200-432.295)

Validates electronic records and signatures for dispute forms submitted electronically in Missouri, ensuring electronic FCBA disputes have the same legal effect as paper submissions.

15 U.S.C. § 1693f - Error Resolution for Electronic Fund Transfers (15 U.S.C. § 1693f)

Establishes error resolution procedures for electronic fund transfers that may be relevant to certain billing disputes involving electronic payments.

15 U.S.C. § 45 - FTC Act Prohibition on Unfair Practices (15 U.S.C. § 45)

Prohibits unfair or deceptive acts or practices in commerce, providing additional federal protection for consumers in billing disputes.

Missouri Consumer Fraud and Deceptive Business Practices Act (Mo. Rev. Stat. § 407.020)

Provides remedies for consumers who have been victims of fraud or deceptive practices in billing, complementing federal FCBA protections.

Missouri Uniform Commercial Code - Good Faith Obligation (Mo. Rev. Stat. § 400.1-304)

Imposes an obligation of good faith in the performance and enforcement of contracts, which applies to credit agreements and billing practices.

15 U.S.C. § 1637 - Disclosure Requirements (15 U.S.C. § 1637)

Mandates specific disclosures for open-end credit plans, including information that must be included in periodic statements that may be subject to disputes.

15 U.S.C. § 1666j - Relation to State Laws (15 U.S.C. § 1666j)

Clarifies that the FCBA does not preempt state laws that provide greater consumer protection, allowing Missouri consumers to benefit from both federal and state protections.

Missouri Unfair Claims Settlement Practices Act (Mo. Rev. Stat. § 375.1000-375.1018)

Prohibits unfair claims settlement practices by insurers, which may be relevant to medical billing disputes in Missouri.

12 C.F.R. § 1026.5 - General Disclosure Requirements (12 C.F.R. § 1026.5)

Sets forth general requirements for disclosures related to open-end credit, which may impact how billing errors are identified and disputed.

Missouri Prompt Pay Statute (Mo. Rev. Stat. § 376.383-376.384)

Requires health insurers to pay clean claims within specific timeframes, which may be relevant to medical billing disputes in Missouri.

15 U.S.C. § 1681s-2 - FCRA Furnisher Responsibilities (15 U.S.C. § 1681s-2)

Requires furnishers of information to credit reporting agencies to correct inaccurate information, which is relevant when disputed billing issues affect credit reports.

Missouri No Surprise Billing Act (Mo. Rev. Stat. § 376.690)

Protects consumers from surprise medical bills from out-of-network providers, providing a state-level mechanism for disputing certain medical charges.

15 U.S.C. § 1692e - FDCPA Prohibition on False Representations (15 U.S.C. § 1692e)

Prohibits debt collectors from using false, deceptive, or misleading representations in connection with the collection of any debt, including disputed amounts.

Frequently Asked Questions

You can dispute several types of billing errors using the FCBA form, including: charges for goods or services you never received or accepted; charges with incorrect amounts or dates; mathematical errors on your bill; failure to reflect payments or credits to your account; bills sent to the wrong address (if you provided written notice of your address change at least 20 days before the billing period ended); unauthorized charges; charges for which you request additional clarification or documentation; and failure to properly reflect returns or refunds. The FCBA covers credit card bills primarily, but similar protections may apply to utility services and medical bills through related consumer protection laws.

Yes, timing is critical. You must send your FCBA dispute form within 60 days of the date the first bill containing the error was mailed to you. This is not the due date of the bill, but the date the statement was sent. Missing this deadline could result in losing your FCBA protections, so it's important to review your bills promptly and act quickly if you spot an error. If your dispute involves a recurring issue, each new billing statement with the error creates a new 60-day window for that specific instance of the error.

To properly complete the form: 1) Include your name, account number, and contact information; 2) Clearly identify each disputed charge with the date, amount, and merchant/provider name; 3) Explain why you believe each charge is incorrect; 4) Include copies (not originals) of any supporting documentation; 5) State the total amount you're disputing; 6) Sign and date the form; 7) Make a copy for your records; and 8) Send the form via certified mail with return receipt requested to the address listed for billing inquiries (not the payment address) on your statement. Some creditors also accept disputes online or by phone, but a written dispute provides the strongest legal protection.

After submission, the creditor must acknowledge your dispute in writing within 30 days of receiving it. They then have two complete billing cycles (but not more than 90 days) to investigate and resolve your claim. During this investigation period, you don't have to pay the disputed amount or any related finance charges, and the creditor cannot report you as delinquent or take collection actions. If the creditor determines the bill is correct, they must explain why in writing. If they agree an error occurred, they must correct the error and refund any related finance charges. If the creditor fails to follow these procedures, they may forfeit the disputed amount up to $50, even if the charge was legitimate.

Yes, you can withhold payment on the disputed portion of your bill while the investigation is pending. However, you must still pay any undisputed portions of your bill by the due date. The creditor cannot charge interest or late fees on the disputed amount during the investigation, nor can they report your account as delinquent to credit bureaus. Be sure to clearly indicate in your dispute form exactly which charges you're disputing and the total amount in question. Keep in mind that if the investigation determines the charge was correct, you'll be responsible for paying the disputed amount plus any legitimate interest that would have accrued.

While the FCBA primarily covers credit card disputes, medical bills have some unique considerations. If you paid a medical bill with a credit card and dispute it, the standard FCBA protections apply. However, for medical bills not yet paid, you should: 1) Request an itemized bill to review charges in detail; 2) Contact your insurance company if coverage issues exist; 3) Send a written dispute to the medical provider detailing the errors; 4) Request a payment hold during investigation; and 5) Consider involving your state's insurance commissioner or healthcare advocate if necessary. Medical billing disputes often involve insurance coverage issues and complex coding that may require specialized assistance from patient advocates or healthcare billing specialists.

If your utility company fails to respond to your FCBA dispute within the required timeframe (acknowledgment within 30 days and resolution within 90 days), you should: 1) Send a follow-up letter referencing your original dispute and noting the missed deadline; 2) File a complaint with your state's public utility commission, which regulates utility companies; 3) Contact your state attorney general's consumer protection division; 4) Submit a complaint to the Consumer Financial Protection Bureau (CFPB) if the bill was paid by credit card; and 5) Consider consulting with a consumer rights attorney if the disputed amount is significant. Utility companies are often subject to both federal consumer protection laws and state-specific utility regulations, which may provide additional avenues for resolution.

Yes, you can use the FCBA dispute form for recurring billing errors, but you should handle these situations strategically. For each new billing statement containing the error, submit a new dispute within the 60-day window. In your subsequent disputes, reference your previous communications and include copies. For subscription services or automatic payments causing recurring errors, explicitly revoke authorization for future charges in writing. Consider also contacting your credit card issuer to block future charges from that merchant. Document all communications thoroughly, as recurring billing issues may require escalation to regulatory agencies like the CFPB or FTC if the creditor fails to permanently resolve the recurring error.