Privacy Act Release Form

Privacy Act Release Form

Under the provisions of the Privacy Act of 1974, I need to have formal authorization from you before making an inquiry to a federal agency on your behalf. This law was enacted to protect individuals from unauthorized disclosure of personal information without their consent.  Therefore, in order for our office to effectively advocate on your behalf, we require you to fill out and return a privacy waiver. The form must be signed by the person whose case is in question.


For non-immigration related matters, a general Privacy Act Release Form can be found here.

For immigration matters, an immigration-specific Privacy Act Release Form can be found here.

Immigration Privacy Act Release Form (05/14/1901:23 PMET )

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    Comments (optional)
    repName Jan Schakowsky  
    helpWithFedAgencyAddress Chicago Office
    5533 N. Broadway
    Chicago, IL 60640
    district 9th District of Illinois  
    academyUSCitizenDate July 1, 2017  
    academyAgeDate July 1, 2017  
    academyApplicationDueDate October 20, 2017  
    repStateABBR IL  
    repDistrict 9  
    repState Illinois  
    repDistrictText 9th  
    SponsoredBills Sponsored Bills  
    CoSponsoredBills Co-Sponsored Bills