Upon completion, a printable page will be generated for you to sign and return to our office. The Privacy Act of 1974 requires Members of Congress and their staff to have written authorization before they may obtain information about an individual's case. We must have your signature to proceed with this type of request. Please include all pertinent information and claim numbers in your correspondence, such as —

• Your Social Security number for a case involving Social Security
• VA claim number for a case with the Department of Veterans Affairs
• Taxpayer identification number (Social Security number for individuals) for an Internal Revenue Service issue
• Copies of any related documents or correspondence that you may have from the agency involved
• Your address, home phone number, and daytime phone number (if different than home) so that we can obtain any additional information from you that might be necessary