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 may be completed completely online.

CLICK THE IMAGE BELOW TO FILL OUT ONLINE PRIVACY FORM

Click here to fill out online privacy release form

PLEASE NOTE: If you live in a neighboring district, you may still be able to complete this online form, but my office will not receive it. Please note which member is indicated upon completion. That is the office that will receive your completed submission, and you should follow up with their staff.

VERIFY YOUR REPRESENTATIVE HERE.


IF YOU PREFER TO PRINT OUR YOUR FORMS AND BRING THEM INTO THE OFFICE, YOU MAY USE THESE FORMS BELOW:

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 PDF iconhere.