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

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    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  
    repPhoto    
    SponsoredBills Sponsored Bills  
    CoSponsoredBills Co-Sponsored Bills  
         
         
         
         
         
  • Office Locations

    Office Name Location Image Map URL
    Washington DC 2229 Rayburn House Office
    Washington, DC 20515
    Phone: (202) 333-4455
    Fax: (202) 333-5522
      http://goo.gl/maps/rqq9i
    Chicago Office
    5533 N. Broadway
    Chicago, IL 60640
    Phone: (773) 506-7100
    Fax: (773) 506-9202
      https://goo.gl/maps/kcpPPTUtvJn
    Evanston Office
    820 Davis Street, Suite 105
    Evanston, IL 60201
    Phone: (847) 328-3409
    Fax: (847) 328-3425
      https://goo.gl/maps/NXL5kij2ybm
    Glenview Office 1852 Johns Drive
    Glenview, IL 60025
    Phone: 847-328-3409
    Fax: 847-328-3425
      https://goo.gl/maps/BhMdf9SwRS72